ORAL CAVITY SQUARE CARCINOMA (SCC)

ORAL CAVITY SQUARE CARCINOMA (SCC)

I/ Introduction: Squamous cell carcinoma represents 90% of malignant tumors of the oral cavity. The combination of tobacco and alcohol increases the risk of developing cancer of the upper aerodigestive tract (UADT) by an average of 15 times. Squamous cell carcinoma is most frequently located on the floor of the mouth, the lateral edges of the tongue and the lower lip. Despite the easy clinical examination of the oral cavity, malignant lesions are generally diagnosed too late; given the importance of early diagnosis, the role of the dental surgeon is essential in the screening of malignant lesions of the oral cavity. It is therefore important to know how to identify an oral ulcer, make a differential diagnosis and perform a biopsy and/or refer the patient to a specialized service.

II/ Definition: A carcinoma is a cancer that develops in an epithelium, that is, a tissue covering internal surfaces (organ lining tissue) or external surfaces (epidermis, for example). A squamous cell carcinoma is a cancer that develops in an external covering tissue (EPIDEMIC)

III/Etiology :

• tobacco/alcohol poisoning. See previous lesson
• Risk lesions: leukoplakia, erythroplakia, lichen planus.

IV/ Clinical: Squamous cell carcinoma generally presents as a painless ulceration with regular, raised, everted edges of firm consistency and an indurated base.

However, it can take on other non-characteristic aspects such as:

• Simple non-ulcerated erythroplastic area
• Punch ulceration
• Budding tumor, rarely pedunculated
• Surface umbilication (with infiltration)
• Book leaf cracking
• Sphacelus crater

V/ Diagnosis and circumstances of discovery :

• Chance discovery
• Regular monitoring of pre-neoplastic lesions
• Recognition by the patient himself
• Functional discomfort
• Highlighting a suspicious lesion
• Alteration of general condition.
• VII/ Clinical Examination:

• Based on palpation and assessment of tumor infiltration
• Slightly painful in the initial stage and painful in a more advanced stage

NB: biopsy is mandatory

VI/ Additional examinations:

1- Biopsy:

• Mandatory / forensic
• Take a sufficient fragment
• In the middle of a tumor and deep inside
• Performed by practitioner/therapist
• Carried out immediately before the therapeutic phase 2- Extension assessment:
• VAES extension report
• Possible extension to cervical lymph node regions 3- Imaging: CT and MRI

VII/ Histological classification:

• type 1: keratinizing squamous cell carcinoma.
• type 2: non-keratinizing squamous cell carcinomas
• type 3: undifferentiated carcinomas

VIII/ Support:

• Surgery
• Chemotherapy and radiotherapy
• Dental:
• Before treatment:

Detection and elimination of oral infectious foci:

• Avulsions:

-Single session under local or locoregional anesthesia or general anesthesia

-Antibiotic therapy during and after surgery

-Extraction followed by regularization and suture

• Conservative care:

– Descaling and polishing

• Removal of carious lesions and fillings
• endocanal treatment and resumption of root canal treatment
• Removal of metal prosthetic elements
• Fluoride prophylaxis:

-Reduced quantity of gel deposit (gutter)

-Application for 10 minutes, preferably in the evening

– during treatment:

Preferably: no surgery Treatment of Radiomucositis:

-Alkaline mouthwash: Na bicarbonate 4 times a day

-Chlorhexidine mouthwash: 0.12% 3 times a day

-Fungicidal mouthwash: Fungizone + chlorhexidine + bicarbonate

-Application: Xylocaine gel

Treatment of oral infections: due to candida albicans

-Systemic antifungal treatment:

Amphotericin B 2g/day in 3 doses/6 to 10 days Nystatin 6 to 9 crushed tablets/6 to 10 days

-Local antifungal treatment:

Miconazole (oral gel 2%) 2 measuring spoons 4X/day for 10 days Treatment of trismus: mechanotherapy

Treatment of Xerostomia:

-Salivary stimulators or sialagogues

-Saliva substitutes

-Pilocarpine hydrochloride

IX/ Conclusion: Squamous cell carcinoma of the oral cavity is a life-threatening condition for patients . Screening is the only way to ensure its prevention and early detection and treatment.

ORAL CAVITY SQUARE CARCINOMA (SCC)

  Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.

ORAL CAVITY SQUARE CARCINOMA (SCC)