The present study proposed to systematically review case reports of metastasis to the oral cavity and compile epidemiological, clinical, radiological, and histopathological features, intending to identify common aspects that may favor early diagnosis of such condition. Articles were found by searching the following databases: PubMed; EMBASE; LIVIVO; Web of Science; LILACS; Scopus and SciELO. The search was carried out in March 2021 by two independent researchers, with no restrictions of publication date or language. A total of 2379 studies were retrieved and 60 articles completely matched inclusion criteria, totalizing 65 cases from 19 countries. Metastasis to oral cavity cases were slightly frequent in males (1.7:1) in the sixth decade of life, manifesting in oral soft tissues (58%, 37/65), mostly originated from the lungs (20%, 13/65) as primary site. Adenocarcinoma was the most reported type of malignacy. In 51% of cases the oral metastatic lesion was the first sign of cancer and 60% of the patients already presented metastasis to other locations. In 23% of the reports, only benign lesions were considered as diagnostic hypothesis, due to a remarkable clinical resemblance to hyperplastic, reactive lesions and odontogenic infections. The survival probability at 6 months after oral metastasis diagnosis was 49%. Metastatic lesions to the oral cavity are often misdiagnosed as benign lesions; due to its severity and quick progression, they must be considered in the differential diagnosis process, conducted by a multidisplinary healthcare team comprising an oral surgeon, especially for patients with history of cancer.
Fanconi anemia is a rare disorder resulting from defects in genes responsible for DNA damage responses. It is characterized by congenital anomalies, aplastic anemia, and a predisposition to cancer. Currently, hematopoietic stem cell transplant (HSCT) is the only curative treatment available for bone marrow failure; however, HSCT increases oral squamous cell carcinoma (OSCC) risk. Here we report the case of a patient diagnosed with Fanconi anemia in childhood who was treated with HSCT and later diagnosed with multiple OSCCs during a 12‐year follow‐up. Despite multiple surgical interventions and radiotherapy regimens, the patient`s health deteriorated. Management of individuals with Fanconi anemia is challenging and must be provided by a multidisciplinary healthcare team to ensure better staging, treatment planning, and coordination.
Surgical dental treatment for cancer patients requires more alertness in propaedeutics when in comparison to normoreactive subjects. Therapy must always be appropriate to the individual's clinical and systemic condition. Under those circumstances, we report a female patient, 51 years old, leucoderma, with a previous history of breast carcinoma. She underwent surgical excision, radiotherapy, and reconstruction of the right breast. The patient described experiencing pain around the 14 tooth area. Clinical and radiographical observations revealed the presence of a protuberance in the vestibule-distal region and in the alveolar ridge of the tooth. The protuberance is related to the local anatomy and previous exodontia, which occurred due to extensive coronary loss, deflection of the remaining cusps, presence of gingival hyperplasia covering the crown, endodontic treatment with the absence of gutta-percha in the region of the pulp chamber, and ankylosis. In her medication history, there was no use of anti-resorptive drugs, which would represent a surgical contraindication. The surgical planning for the region of the 14 tooth included flap making and vestibular and bone spike osteoplasty, with beveling of the osteotomy margins. An antibiotic was prescribed for 7 days and the patient should start taking it 2 days before the surgery. The subject had good post-surgical tissue repair and probable posterior prosthetic rehabilitation. Therefore, it is fair to conclude that careful anamnesis sets up an adequate surgical propaedeutics with a good prognosis, which may improve the quality of life of cancer patients.
Head and Neck Squamous Cell Carcinoma (HNSCC) constitute more than 90% of the head and neck cancer cases, often presenting as a locally advanced disease. As techniques are improving, life expectancy of HNSCC patients have risen overtime, leading to a larger number of people facing late sequelae that often culminate in a direct and significant impact on their quality of life. For those individuals, recurrence may represent a concern for curative attempts and overall survival rates. This paper reports a clinical case of a long-term HNSCC survivor who developed multiple oral sequelae from previous cancer treatment and recent second malignancies; in order to proceed for re-irradiation, she was referred for oral assessment. Due to her age and comorbidities, private professionals reportedly refused to provide oral care, causing an immense delay to her oncology treatment that led to the progression of diverse oral symptoms and cancer itself. Considering the urgency of head and neck re-RT, the outlined oral treatment plan was conservative and included scaling and root planing, oral prophylaxis, direct resin composite restorations and hygiene orientation, in a single session. She was also referred for low-level lasertherapy.Afterwards, her health had deteriorated to such a stage she did not qualify to actually proceed for re-RT, and instead was treated with end-of-life care until the time of her death, 8 months after the above-mentioned appointments. The authors believe the prolonged search for proper oral care was significant to her already poor prognosis, as it caused an immense delay to the start of the cancer treatment.
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