CASE REPORT   

European Journal of Oral and Maxillofacial Surgery 2021 December;5(3):135-9

DOI: 10.23736/S2532-3466.21.00250-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A rare finding following a wisdom tooth extraction

Natasha BHALLA ✉, Harry DYM

Oral and Maxillofacial Surgery, Brooklyn Hospital Center, Brooklyn, NY, USA

Intraosseous adenoid cystic carcinoma is a rare, malignant carcinoma, most commonly found in the mandible. As of the year 2017, authors reported 45 cases of intraosseous adenoid cystic carcinoma to date. We presented the case of a 39-year-old female with no significant medical history. She presented with a complaint of 10/10 pain associated with tooth #32. Clinical examination revealed grade 3 mobility and tooth pain associated with tooth #32. A dental Panorex revealed a periapical radiolucency associated with #32. During that visit, tooth #32 was extracted and an incisional biopsy was obtained. The patient was also sent for a CT Maxillofacial with Contrast. The histopathological diagnosis of the tissue was that of intraossesous adenoid cystic carcinoma. The tumor involved the mandibular bone and squamous mucosa. The patient was treated with a right segmental mandibulectomy, right selective neck dissection levels I-III and reconstruction with free fibula osteocutaneous flap. Intraosseous adenoid cystic carcinoma is known for its prolonged course and a delayed onset of possible distant metastases. The long-term survival of these patients is therefore poor. As per the comprehensive review by Garcia de Marcos et al., pain and swelling are the most reported symptoms. In the previously reported literature, the most common radiographic sign is radiolucent destruction of bone with irregular margins. The non-specific clinical and radiographic symptoms associated with IACC stresses the importance of histopathological analysis. There are three histological types: solid, cribriform and tubular. The solid histological type demonstrates poor prognosis and is more likely to involve distant metastases compared to the other histological types. Treatment modalities include surgery, radiotherapy and chemotherapy. The aim of this study was to report the diagnosis of a rare malignancy following a tooth extraction.

KEY WORDS: Tooth extraction; Carcinoma, adenoid cystic; Surgical procedures, operative