56-year-old male nonhealing extraction sockets within enlarging, painful, nodular mass with ulceration maxillary right molar region. Teeth 15, 16, and 17 had been extracted 2 months before due to class 2 motility attributed to periodontal disease. Received multiple short courses of oral antibiotics, amoxicillin, metronidazole, and clindamycin.
30-pack-year smoking history. 3 × 2 cm red, exophytic, nodular mass extending from buccal gingiva of tooth 14 with class 1 motility to maxillary tuberosity and hard palate. Soft and bled profusely. No palpable cervical lymph nodes.
Osteolytic radiolucent lesion from the upper right first premolar to right third molar eroded right maxillary sinus floor.
Incisional biopsy OCC.
CT with intravenous contrast osteolytic lesion right posterior maxilla involved maxillary sinus, extended anteriorly tooth 14 and posteriorly pterygoid process of the sphenoid without infiltrating it.
No cervical lymph node on CT neck. Magnetic resonance imaging (MRI)- high-intensity within right maxilla for 3 cm from the premolar region to the maxillary tuberosity, cephalocaudally for 2 cm from the pterygoid process of the sphenoid to the alveolar crest, and buccally/palatally for 1.5 cm, widely involving the right maxillary sinus.
CT of the chest and abdominal ultrasound, neither of which yielded any pathological findings. Tumor was staged as T4N0M0. Results of laboratory studies (including complete blood count, biochemical profile, and coagulation tests) were within normal.
Segmental maxillectomy extending from tooth #12 anteriorly to the maxillary tuberosity posteriorly and up to the lower third of the pterygoid process of the sphenoid was performed. Free full-thickness skin graft, from the right supraclavicular, placed in defect with an obturator.
Histopathology: highly differentiated, stratified, squamous epithelium with keratin-filled crypts resembling rabbit burrows. Mitosis rate of the epithelial cells was normal, mild atypia.
Patient underwent facial, skull and neck CT scans 6 and 18 months postoperatively, no local recurrence or nodal metastasis.
Complete surgical resection with a safety margin is considered the treatment of choice for OCC.
OCC has rarely been associated with regional (cervical lymph node) and/or distant (lung) metastases. No neck dissection, given the lack of either clinical or imaging findings to suggest nodal metastasis.
The role of chemotherapy and radiotherapy in the treatment of OCC remains controversial. Repeated surgical resection for recurrent cases. OCC does not seem to respond to chemo, and radiation induces anaplastic transformation.
Conclusions
OCC is a rare, well-differentiated variant of OSCC.