Introduction: Oral metastases are rare and represent 1% oro-facial neoplasms. The lung is the most common primary site for oral metastatic tumors. The diagnosis is based on histological analysis. Oral metastases have been associated with poor prognosis and is no longer a proven treatment. It was found in a 58-year old man diagnosed with lung cancer with a voluminous mandibular tumefaction following dental avulsion. The panoramic X-ray showed an area of osteolysis compared to the extraction site. The histological and immunohistochemistry of the lesion showed a positivity of the marker CK7 and a negativity of TTF1, in favor of a lung origin. The biomolecular analysis revealed a mutation on the BRAF gene confirming the metastasis primitive origin. Treatment by surgical resection was performed palliatively. Comments: The diagnosis of an oral metastasis remains difficult and is based on the histological analysis and finding immune markers. Molecular biology is sometimes required for theranostics. Treatment options include surgical resection, radiotherapy, and/or chemotherapy. They are sometimes limited to preserve the quality of life. The prognosis of patients with oral metastases is very poor. Conclusion: Oral metastases are rare, and the diagnosis remains difficult.
Introduction: Orthognathic surgery can be a treatment for occlusal, oro-facial functional disorders and esthetics discrepancies as well as for obstructive sleep apnea. It is often practiced after an orthodontic preparation, but in edentulous patients, the preparation can be replaced with implant supported prosthesis to simulate the final occlusion. Observation: A patient presenting severe obstructive sleep apnea, vertical and sagittal insufficiency of the lower third of the face and poor dental health was treated with a guided mandibular advancement and an almost complete implant supported prosthesis rehabilitation. At first, the implants were placed and immediately loaded, giving the patient a class 2 occlusion. Then, an orthognathic surgery was performed, giving the patient a class 1 occlusion, and then the final prosthesis was made. Commentaries: The interest of this case is the combined treatment of the obstructive sleep apnea, the dental and facial deformities by mandibular retrognathia and the edentulous jaws. The gold standard for obstructive sleep apnea is a maxillary and mandibular advancement. In this case, for esthetic and anatomic reasons, a mandible propulsion alone has been performed, showing a positive and stable result for the treatment of obstructive sleep apnea. The use of surgical guide permitted to plan the treatment with more accuracy. Conclusion: This case combines a fixed prosthetic rehabilitation, which permitted to guide the orthognathic surgery and the treatment of obstructive sleep apnea.
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