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Squamous cell carcinoma developing in conjunction with a mandibular staple bone plate
J Oral Maxillofac
Surg
41:265-268.1983
Squamous Cell Carcinoma Developing in Conjunction with a Mandibular Staple Bone Plate KURT E. FRIEDMAN,
DDS, MS,* AND STEPHEN
Report of a Case
Discussion
A 65-year-old white man sought a second opinion re-
garding the diagnosis and treatment of chronic irritation on the lingual gingiva under the cast gold bar of the man-
It is obviously not possible to determine whether the bone plate contributed to development of the cancer in this case. There is no doubt, however, that it acted as a nidus of continued irritation. Although irritation is not a proven cause of cancer, it can be a contributory factor. It cannot be emphasized enough that proper design of the prosthetic appliance, periodic adjustments, and continued follow-up care are mandatory in patients who have received the staple bone implant. Moreover, as indicated by this case, any tissue removed from around the posts, even if clinically considered to be merely hyperplastic, should be submitted for histologic examination.
dibular staple, and involving the lingual aspect of the right transosseous pin. Extreme pain was experienced when the lower denture was placed in function. In February of 1978 the patient had undergone a floorof-the-mouth vestibuloplasty without removal of the mucosa along the superior alveolar crest, followed by splitthickness skin grafting from the right thigh. In March 1978 a five-pin staple bone plate was inserted (Fig. 1). A temporary denture was constructed by the prosthodontist postoperatively. Construction and insertion of the f&al prosthesis followed three months later. Subsequently’, the patient complained of constant irritation under the gold bar, anterior lingual flange, and right transosseous pin. The condition did not improve with numerous adjustments and continuous removal of the gingival tissue around the right transosseous pin over a six-month period. The patient had smoked two packs of cigarettes per day for the past 40 years. Oral examination showed raised, erythematous tissue under the gold bar extending from the right transosseous pin to within 4 mm of the left transosseous pin. Poor oral was observed
around
the pins. There
MD-t
dehiscence around the left transosseous pin and gingival hyperplasia (Fig. 2). The erythematous tissue continued around the right transosseous pin and extended inferiorly on the lingual aspect of the anterior mandible and floor of the mouth. The orifice of Wharton’s duct was involved bilaterally. The lesion appeared ulcerated, necrotic, and indurated, with erythematous borders. The lesion was painful to palpation and bled freely. No limitation of motion of the tongue was observed. No cervical lymphadenopathy was found. A panoramic radiograph showed resorption of the superior aspect of the alveolar ridge, with bone destruction around the right transosseous pin (Fig. 3). A biopsy of the lingual gingiva under the gold bar and around the right transosseous pin revealed keratinizing squamous cell carcinoma (Fig. 4).
The mandibular staple bone plate is currently used as one of the surgical alternatives for correction of the atrophic mandible. Functional success without major complication has been achieved in 90% of over 400 reported cases. ’ The most common surgical problem appears to be the occurrence of gingival hyperplasia around the transosseous pin.” This is usually secondary to a combination of factors, namely, movable mucosa, gingival inflammation, poor oral hygiene, and poor prosthetic design. This paper reports an unusual complication in conjunction with use of the staple bone plate.
hygiene
E. VERNON,
Summary A case of squamous cell carcinoma has been observed in conjunction with a mandibular staple bone plate. Because minor complications such as chronic irritation and gingival hyperplasia can possibly lead to more major sequelae, continuous follow-up care and observation are of the highest importance to the clinician who is involved in placement of the staple bone plate.
was labial
* Chief, Division of Oral & Maxillofacial Surgery, St. Francis Hospital, Miami Beach, FL 33141. t Clinical Assistant Professor of Pathology, University of Miami School of Medicine; Staff Pathologist, St. Francis Hospital, Miami Beach. Address correspondence and reprint requests to Dr. Friedman: 975 Arthur Godfrey Rd, Suite 204, Miami Beach, FL 33140.
265
266
SQUAMOUS
CELL
CARCINOMA
AND
MANDIBULAR
FIGURE 3. Ahovc~. Panoramic radiograph of bone around the right transosseous pin.
BONE
showing
PLATE
resorption
FIGURE 4. Bc/o~t,. Photomicrograph of moderately entiated squamous cell carcinoma, (Hematoxylin and original magnification X2.50.)
differeosin.
References FIGURE sertion.
I.
Ahot~.
Appearance
of staple
bone
plate after
in-
FIGURE 2. Exophytic granular tissue around the transosseous pin (c.rrr~r) and extending onto the floor of the mouth (hrlot~). J Oral Maxlllofac
I. Small IA: Survey of experience with the mandibular staple bone plate. J Oral Surg 36:604. 1978 2. Small IA: Metal implants and the mandibular staple bone plate. Chalmers J. Lyons Memorial Lecture. J Oral Surg
33:.571. 1975
Surg
41:266-267. 1983
Vein Graft Repair of a Chronic Duct Fistula N. ANANTHAKRISHNAN, Lacerations and interruptions of Stensen’s duct are not uncommon with facial injuries or during drainage of a parotid or facial abscess. ‘Z In longstanding cases of complete transection, especially of the masseteric portion of the duct, the distal portion trophies. In such situations ablative surgery has been recommended even though it is associated with significant morbidity.3 A technique is de-
* Lecturer in Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. Address correspondence and reprint requests to Dr. Ananthakrishnan.
Parotid
MBBS, MS, MNAMS* scribed gland.
which
is an alternative
to excision
of the
Report of a Case An 18-year-old male patient had a fistula of the masseteric part of the parotid duct resulting from drainage of a facial abscess at the age of 6 months. Two earlier attempts at direct repair at the ages of 5 and 11 years had failed (Fig. 1). On intraoral examination, the orifice of the duct was identified as a small dimple opening into a blindly ending tract about 5 mm deep. This was confirmed by a sialogram which showed extravasation of contrast medium on injection, whereas the duct system could not be visu-
Surg
41:265-268.1983
Squamous Cell Carcinoma Developing in Conjunction with a Mandibular Staple Bone Plate KURT E. FRIEDMAN,
DDS, MS,* AND STEPHEN
Report of a Case
Discussion
A 65-year-old white man sought a second opinion re-
garding the diagnosis and treatment of chronic irritation on the lingual gingiva under the cast gold bar of the man-
It is obviously not possible to determine whether the bone plate contributed to development of the cancer in this case. There is no doubt, however, that it acted as a nidus of continued irritation. Although irritation is not a proven cause of cancer, it can be a contributory factor. It cannot be emphasized enough that proper design of the prosthetic appliance, periodic adjustments, and continued follow-up care are mandatory in patients who have received the staple bone implant. Moreover, as indicated by this case, any tissue removed from around the posts, even if clinically considered to be merely hyperplastic, should be submitted for histologic examination.
dibular staple, and involving the lingual aspect of the right transosseous pin. Extreme pain was experienced when the lower denture was placed in function. In February of 1978 the patient had undergone a floorof-the-mouth vestibuloplasty without removal of the mucosa along the superior alveolar crest, followed by splitthickness skin grafting from the right thigh. In March 1978 a five-pin staple bone plate was inserted (Fig. 1). A temporary denture was constructed by the prosthodontist postoperatively. Construction and insertion of the f&al prosthesis followed three months later. Subsequently’, the patient complained of constant irritation under the gold bar, anterior lingual flange, and right transosseous pin. The condition did not improve with numerous adjustments and continuous removal of the gingival tissue around the right transosseous pin over a six-month period. The patient had smoked two packs of cigarettes per day for the past 40 years. Oral examination showed raised, erythematous tissue under the gold bar extending from the right transosseous pin to within 4 mm of the left transosseous pin. Poor oral was observed
around
the pins. There
MD-t
dehiscence around the left transosseous pin and gingival hyperplasia (Fig. 2). The erythematous tissue continued around the right transosseous pin and extended inferiorly on the lingual aspect of the anterior mandible and floor of the mouth. The orifice of Wharton’s duct was involved bilaterally. The lesion appeared ulcerated, necrotic, and indurated, with erythematous borders. The lesion was painful to palpation and bled freely. No limitation of motion of the tongue was observed. No cervical lymphadenopathy was found. A panoramic radiograph showed resorption of the superior aspect of the alveolar ridge, with bone destruction around the right transosseous pin (Fig. 3). A biopsy of the lingual gingiva under the gold bar and around the right transosseous pin revealed keratinizing squamous cell carcinoma (Fig. 4).
The mandibular staple bone plate is currently used as one of the surgical alternatives for correction of the atrophic mandible. Functional success without major complication has been achieved in 90% of over 400 reported cases. ’ The most common surgical problem appears to be the occurrence of gingival hyperplasia around the transosseous pin.” This is usually secondary to a combination of factors, namely, movable mucosa, gingival inflammation, poor oral hygiene, and poor prosthetic design. This paper reports an unusual complication in conjunction with use of the staple bone plate.
hygiene
E. VERNON,
Summary A case of squamous cell carcinoma has been observed in conjunction with a mandibular staple bone plate. Because minor complications such as chronic irritation and gingival hyperplasia can possibly lead to more major sequelae, continuous follow-up care and observation are of the highest importance to the clinician who is involved in placement of the staple bone plate.
was labial
* Chief, Division of Oral & Maxillofacial Surgery, St. Francis Hospital, Miami Beach, FL 33141. t Clinical Assistant Professor of Pathology, University of Miami School of Medicine; Staff Pathologist, St. Francis Hospital, Miami Beach. Address correspondence and reprint requests to Dr. Friedman: 975 Arthur Godfrey Rd, Suite 204, Miami Beach, FL 33140.
265
266
SQUAMOUS
CELL
CARCINOMA
AND
MANDIBULAR
FIGURE 3. Ahovc~. Panoramic radiograph of bone around the right transosseous pin.
BONE
showing
PLATE
resorption
FIGURE 4. Bc/o~t,. Photomicrograph of moderately entiated squamous cell carcinoma, (Hematoxylin and original magnification X2.50.)
differeosin.
References FIGURE sertion.
I.
Ahot~.
Appearance
of staple
bone
plate after
in-
FIGURE 2. Exophytic granular tissue around the transosseous pin (c.rrr~r) and extending onto the floor of the mouth (hrlot~). J Oral Maxlllofac
I. Small IA: Survey of experience with the mandibular staple bone plate. J Oral Surg 36:604. 1978 2. Small IA: Metal implants and the mandibular staple bone plate. Chalmers J. Lyons Memorial Lecture. J Oral Surg
33:.571. 1975
Surg
41:266-267. 1983
Vein Graft Repair of a Chronic Duct Fistula N. ANANTHAKRISHNAN, Lacerations and interruptions of Stensen’s duct are not uncommon with facial injuries or during drainage of a parotid or facial abscess. ‘Z In longstanding cases of complete transection, especially of the masseteric portion of the duct, the distal portion trophies. In such situations ablative surgery has been recommended even though it is associated with significant morbidity.3 A technique is de-
* Lecturer in Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. Address correspondence and reprint requests to Dr. Ananthakrishnan.
Parotid
MBBS, MS, MNAMS* scribed gland.
which
is an alternative
to excision
of the
Report of a Case An 18-year-old male patient had a fistula of the masseteric part of the parotid duct resulting from drainage of a facial abscess at the age of 6 months. Two earlier attempts at direct repair at the ages of 5 and 11 years had failed (Fig. 1). On intraoral examination, the orifice of the duct was identified as a small dimple opening into a blindly ending tract about 5 mm deep. This was confirmed by a sialogram which showed extravasation of contrast medium on injection, whereas the duct system could not be visu-