The case described in our work is that of a 72-year-old woman who has a 10-year history of chondrosarcoma intervened successfully and who has undergone several osseous reconstructions.
Hysterectomy for myomas and hypertension treated with angiotensin-II receptor blockers.
The first right lower molar was removed by vertical fracture, two years ago it was endodontically treated.
After a waiting period of 4 months for bone regeneration of the post-exodontia defect and after a radiological study with CAT, a screwed implant Tapered Screw Vent MTX 4,1 microtextur was placed.
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After four months of waiting for osteosynthesis, the patient was operated on to place a 4 mm wide x 3 mm high titanium healing pillar.
In this visit, healing of peri-implant tissues was observed, without signs or symptoms of inflammation.
There was no clinical or radiographic evidence of early failure of fixation.
After 15 days, the patient was referred to the «disease continuum» and a slightly elevated inflammatory lesion was observed around the healing pillar.
Ultrasound and chlorhexidine cleaning was performed and the pillar was changed to another sterile one to avoid irritation and bacterial colonization.
After a further 10 days of waiting, an excretory raised lesion was observed around the perimeter of the healing pillar.
It was red, papillomatous, multilobulated, soft to the touch, and about two centimeters in diameter.
She had no spontaneous pain or physical examination.
He was not ulcerated and was easy to detach with a spoon with little bleeding.
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The radiovisi study showed no bone loss around the implant and the rest of the oral and general examination was normal, except for cervical adenopathies.
Two incisional biopsies were taken from the lesion described and sent to an anatomopathologist for histopathological study, which is described below: «neoformation of epithelial lineage and squamous differentiation that shows prominently foamy nucleus epithelitic pleocytoplasm consisting of chromatin
These cells show differentiation that targets the presence of parablastic balloons and isolated keratosis.
A stroma of edematous connective tissue with mild chronic nonspecific inflammatory infiltrate and presence of foreign body multinucleated giant cells is accompanied.`
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Diagnosis: Verrucous carcinoma.
The patient was referred to the Maxillofacial Surgery Service of the Zone Hospital.
Computed tomography (CT) showed no underlying bone lesions or periimplant radiologic manifestation.
Under general anesthesia a marginal mandibular resection was performed with implant removal and the adjacent parts 45 and 48 together with ganglionic dissection right cervical including spaces I, II, III and IV were not abundant adenopathy II.
After successive hospital revisions, at 3 months he presented a new lesion of 5 mm in diameter in the area of the intervened gingiva that was informed histopathologically of «recurrence of squamous cell carcinoma» and underwent resection of new margins.
After four years of follow-up the patient has not shown recurrence.
