P53-Positive squamous cell carcinoma originating from an odontogenic cyst

Abstract

Intraoral squamous cell carcinoma originates pri- marily from the oral mucosa and only secondarily in- vades adjacent osseous structures. Such primary squa- mous cell carcinomas are frequently associated with risk factors including tobacco use and alcohol con- sumption. Although occurrences of squamous cell car- cinoma originating fi-om odontogenic cysts have been described in the literature, there are few case reports where this has been confirmed histologically.'x2 In this report we present the early interception of a p53-posi- tive squamous cell carcinoma originating from an odontogenic cyst in a 37-year-old woman, and its sub- sequent management. noma was made (Fig 2A). The neoplasm appeared to be originating from the cystic epithelium (Fig 2B). The patient was referred for further management. At the time of examination the patient had a 2-cm, non- healing, extraction socket in the right posterior mandible. The patient denied any of the known risk factors associated with oral squamous cell carcinoma. Magnetic resonance im- aging and chest radiographs revealed no abnormalities in the neck or chest. A computerized axial tomographic scan of the mandible showed that the lesion had been confined to bone, with both buccal and lingual cortices intact. The liver function tests were within normal limits. Treatment included a wide segmental resection of the mandible with an incontinuity supraomohyoid neck dissec- tion for staging, and immediate reconstruction with a free fibula bone graft (preoperative angiograms were obtained of both the patient's lower extremities to determine the segmen- tal blood supply to the fibula via the peroneal artery). The posterior cut of the mandibular resection was made from the midcoronoid notch to the angle, and the anterior cut was made in the first premolar region. Prior to making the osteot- omies a malleable template was adapted along the lateral aspect of the mandible to allow precise contouring of a re- construction plate. The mandibular discontinuity was then bridged with a 15-hole (Synthes, Paoli, PA) 2.4-mm mandib- ular reconstruction plate.