Conservative Endodontic Management in a Patient with Metastatic Carcinoma. Review and Report of a Case

Abstract

Introduction: Carcinoma is defined as a malignant neoplasm that forms from epithelial tissue, of unknown and multifactorial etiology, related to tobacco and alcohol consumption habits; with rapid growth, local tissue destruction and ability to metastasize. Objective: To present conservative endodontic management in a patient with metastatic carcinoma. Case presentation: A 69-year-old Mayan-speaking male patient, who came for evaluation and treatment of teeth 32 (with fenestrated crown) and 33, both symptomatic. During the anamnesis, he reported being a former smoker and alcoholic, being under analgesic treatment for pain from an indurated mass in the left cervical lymph nodes, chronic otitis media and chronic otorrhea, without pain or fever, with one year of evolution. Upon the extraoral clinical inspection, the enlarged and indurated left cervical lymph node region was palpated and it extended to the submandibular and preauricular area. He manifested mild odynophagia and dysphagia. Chronic apical periodontitis (32) and aseptic partial pulp necrosis (33) were diagnosed. Treatment of both teeth was performed without anaesthesia, atraumatic isolation, opening, apical stop, StepBack instrumentation technique, irrigation of the canal with 5% sodium hypochlorite (NaClO) for disinfection and shaping, drying and placement of calcium hydroxide (Ca(OH)₂), sealing with resin. No gutta-percha obturation was performed. After the endodontic treatment, an interconsultation with Oncology was carried out, doing a biopsy of the left cervical nodule by fine needle aspiration, showing metastasis of poorly differentiated carcinoma with extensive necrosis. Primary tumour was located using contrast ultrasound: carcinoma in the larynx. Conclusions: Management was conservative, due to suspicion of the neoplastic condition that the patient presented.