We report the case of a 63-year-old patient referred to our dentist's consultation complaining of a painful mass in the right lower canine region, which had been diagnosed four weeks earlier.
She had a history of sensorineural hearing loss, dysphagia, sore throat, weight loss or fever.
Physical examination revealed minimal facial swelling.
Intraoral examination revealed a bulging of the right mandibular lingual table at the canine level, with vestibulization.
No cervical lymphadenopathies were detected.
Orthopantomography showed a radiolucent area with regular edges, in relation to the canine, of 2 cm maximum diameter.
It was diagnosed as benign cystic pathology.
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An incisional biopsy was performed under local anesthesia.
Microscopic studies concluded that it was a malignant neoplasm of spindle cells.
As an extension study, a CT scan of the chest, abdomen and pelvis was performed, which was absolutely negative.
The patient underwent surgery under general anesthesia three weeks after her first visit.
At that time, he presented a mass that had emerged from the vestibular side at the biopsy site.
A right supraomohyoid neck dissection was performed, with excision of the submandibular gland and regional lymph nodes.
The mandible was resected from the symphysis to the right lower first molar.
The surgical specimen and neck dissection were macroscopically tumor-free.
A reconstruction plate was used for the primary reconstruction of the defect.
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In the immediate postoperative period, the patient developed a cervical infection, with orocervical communication, despite the nasogastric tube placed at the time of surgery.
Despite intravenous antibiotic treatment, the patient did not improve and the reconstruction plate was removed under general anesthesia.
The patient was discharged on postoperative day 20.
Immunohistochemical study of biopsy and surgical specimen showed that tumor cells were reactive to vimentin and muscle-specific actin.
They were also reactive to desmin.
Finally, a grade II leiomyosarcoma was diagnosed.
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The patient has been regularly followed up in our clinic 15 months prior to diagnosis and is free of recurrence or metastasis.
