The treatment of squamous cell carcinoma of the retromolar trigone is controversial. Pdf populationbased study of treatment outcomes in. Aug 01, 2016 retromolar trigone carcinoma may present with pa in or bleeding in the oral cavit y. Squamous cell carcinoma scc of the retromolar trigone is uncommon, accounting for 1.
Squamous cell carcinoma of the retomolar tigone radiology key. Most patients present with early cancers of the lip, which are highly curable by surgery or by radiation therapy with cure rates of 90% to 100%. Tnm staging of head and neck cancer and neck dissection. Surgery to remove the tumor, lymph nodes, and part of the jawbone, with or without radiation therapy. On examination, a mass in the retromolar trigone anterio r tonsillar pillar area may be evident. The retromolar trigone is coded using the same summary stage scheme as the gingiva or gums. Squamous cell carcinoma scc is the most common cancer of the oral cavity and accounts for up to 95% of all cancers in this anatomical region. Treatment outcomes were analyzed for retromolar trigone squamous cell carcinoma. It is roughly triangular shaped and extends superiorly towards the maxilla along the anterior surface of the mandible related pathology. Treatment outcomes of rare retromolar trigone squamous cell.
Retromolar trigone carcinoma may present with pa in or bleeding in the oral cavit y. A clinical trial of chemotherapy before or aftersurgery. The retromolar trigone is an oral cavity subsite that consists of the mucosa posterior to the last mandibular molar. Squamous cell carcinoma of the retromolar trigone rmt.
Retromolar trigone squamous cell carcinoma treated with radiotherapy alone or combined with surgery. Methods we have retrospectively evaluated records of 62 patients treated in head. Oral carcinoma of the retromolar trigone, maxillary. He retromolar trigone rmt is a small triangular subsite of the oral cav. A 65yearold woman with squamous cell carcinoma of the retromolar trigone rtr. A case report of metastasis of malignant mesothelioma to. Populationbased study of treatment outcomes in squamous cell carcinoma of the retromolar trigone. Treatment of squamous cell carcinoma of the retromolar trigone.
Malignant mesothelioma is a rare and aggressive tumor with a poor prognosis. The infratemporal fossa should also be included in the radiation field for tumor adjacent to these nerves with extensive perineural invasion and for tumor invading the pterygoid muscle, which is most commonly seen in patients with retromolar trigone cancer or tonsil cancer. Retromolar trigone the retromolar trigone rmt is an illdefined triangular area in the oral cavity posterior to the upper and lower third molar teeth, with the maxillary tuberosity at its apex. An unusual case of mandibular squamous cell carcinoma in. Lip and oral cavity cancer treatment adult pdqhealth. To our knowledge, this is the first case report of pleural mesothelioma metastasized to the retromolar trigone. Diagnostic approach to retromolar trigone cancer by. Surgery, radiotherapy, and chemotherapy as combined modalities have been used but high recurrence rates result in poor outcome. Use of computed tomography in the assessment of mandibular. Bscc is more aggressive and has a poorer prognosis, although histologically, it is associated with squamous cell carcinoma and squamous atypia. It is associated with an increased risk of thyroid, breast and endometrial cancer but many manifestations can be found in the head and neck region, some of which are pathognomonic.
The likelihood of cure after treatment for retromolar trigone squamous cell carcinoma was in. Tumours that involve this area can extend to nearby muscles. Background retromolar trigone squamous cell carcinoma is relatively uncommon and due to its complex anatomy has always remained a challenge in terms of locoregional control and survival. Comprehensive clinical examination revealed papillomatous skin lesions, macrocephaly and gingival hypertrophy. Between june 1966 and august 2003, 99 patients were treated with radiotherapy alone 35 patients or radiotherapy combined with surgery 64 patients. Design we retrospectively examined 46 patients with squamous cell carcinoma of. Patients usually have a long history of tobacco abuse, often combined with heavy ethanol consumption. Only a few cases with metastasis to oral gingiva are reported. C031 lower gum c062 retromolar area gingiva, trigone note 1. Oblique coronal reconstruction, showing rtr cancer c spreading caudally, towards the mylohyoid muscle my insertion. Retromolar trigone scca rads iowa head and neck protocols. A case report of metastasis of malignant mesothelioma to the. A subcutaneous mandibulotomy approach for a salivary clear. Retromolar trigone carcinoma treated by primary radiation.
Management of the clinically negative neck in early squamous cell carcinoma of the oral cavity scharukh jalisi, md department of otolaryngologyhead and neck surgery, vanderbilt university medical center, s2100 medical center north, nashville, tn 37232, usa epidemiology oral cavity squamous cell carcinoma is the sixth leading cause of cancer. Diagnostic approach to retromolar trigone cancer by multiplanar computed tomography reconstructions. The retromolar area is a rare site for the presentation. Original article retromolar trigone carcinoma treated by primary radiation therapy an alternative to the primary surgical approach. Routes of tumour spread from the retromolar trigone and buccal mucosa tween the pterygoid hamulus and the posterior end of the mylohyoid ridge of the mandible figure 2. Pdf controversies in the management of retromolar trigone.
If cancer is in the retromolar trigone the small area behind the wisdom teeth, treatment may include the following. Squamous cell carcinoma of the left retromolar trigone, involving the gingiva around the lower molar. The retromolar trigone rmt in the dry mandible is a triangular area bounded by temporal crest on the medial side, anterior border of ramus on the lateral side, and base posterior to the socket for the third molar. Fifty patients with rmt squamous cell carcinoma were treated with surgery andor radiation or chemoradiation therapy between july 1993 and june 2004 at. Aug 01, 2014 the retromolar area is a rare site for the presentation. Tumor at the level of retromolar trigone and right tonsil. This lesion may be associated with dysplastic m ucosal changes in the oral cavit y. S quamous cell carcinoma of the retromolar trigone is relatively uncommon. Retromolar trigone carcinoma treated by primary radiation therapy. Basaloid squamous cell carcinoma bscc is a rare distinct histologic variant of squamous cell carcinoma of the head and neck region. Area between primary oral tongue cancer and regional lymph nodes. This schema is based on the uicc chapter lip and oral cavity, pages 2529. Retromolar trigone tumors european journal of radiology. The study confirmed that oral cancer remains serious problem in terms of risk factors, delayed diagnosis and overall survival rates.
Overall survival rate depended also on the stage and grade of differentiation of the tumor. Nci dictionary of cancer terms national cancer institute. Squamous cell carcinoma of the retromolar trigone rmt scc is a relatively uncommon primary site for oral cavity malignancy. Primary squamous cell carcinoma of retromolar area. Determination of mandibular invasion is significant for planning therapy and determining progn. It is the core of diagnosis, treatment planning, application of therapeutics from multiple disciplines, recovery, followup, and scientific investigation. Aug 12, 2008 we report a novel subcutaneous mandibulotomy approach for the excision of a rare clear cell carcinoma, not otherwise specified nos of the retromolar trigone. The prognosis for this site tends to be poor because of the advanced stage of. Squamous cell carcinoma of the oral cavity remains to be one of the most difficult malignancies to control. Pertinent imaging issues, optimal imaging methods, treatment options and a recommended reporting checklist emphasizing the information to be conveyed by the radiologist to the surgeon.
Mazziotti s, pandolfo i, dangelo t, mileto a, visalli c, racchiusa s, blandino a, ascenti g can assoc radiol j 2014 nov. Neoplasms of retromolar trigone have important peculiarities due to their spatial relationships with the surrounding structures. Treatment outcomes of patients with primary squamous cell. Pdf retromolar trigone carcinoma treated by primary radiation. Pdf diagnostic approach to retromolar trigone cancer by. It is a relatively uncommon site for oral squamous cell carcinoma. Retromolar trigone squamous cell carcinoma radiology. Dec 27, 2015 squamous cell carcinoma of the retromolar trigone epidemiology. Despite improvement in the diagnostic and management methods, the prognosis of oral cancer is still unpredictable. Gum, lower and retromolar area excluding malignant. The retromolar trigone rmt is a subsite of the oral. Small cancers of the retromolar trigone, hard palate, and upper gingiva are highly curable by either radiation therapy or surgery with survival rates of as much as 100%. Other sites include the buccal mucosa, gingiva, palate, and retromolar. Pain in the oral cavity associated with an indurated mucosa of the right retromolar trigone.
Treatment of squamous cell carcinoma of the anterior. After 8 months of followup there have been no complications or lesion recurrence. Retromolar trigone squamous cell carcinoma is relatively uncommon and due to its complex anatomy has always remained a challenge in. The optimal therapy for tumors originating in the retromolar trigone and anterior faucial pillar remains controversial, although a combinedmodality therapy is preferred. Lip and oral cavity cancer treatment adult pdqpatient. Patients treated with surgery and radiotherapy had a better outcome than those treated with radiotherapy alone. Followup data were obtained for all patients using the clinical record notes and correspondence with the referring physician, the patient, or the patients family. Oral carcinoma of the retromolar trigone, maxillary alveolus. Although rmt tumors are uncommon as compared to other oral subsites, squamous cell carcinoma is the most common histopathological presentation. This series of works seeks to examine the behaviour and management of oral squamous cell carcinoma at two uncommon sites for which data is lacking.
If your results show any signs of early stage oral cavity cancer, your doctor may recommend that you have surgery. The retromolar trigone rmt is a triangular area situated behind the molars between the posterior portion of the maxillary and mandibular alveolar ridges. The objective of the present study was to describe a clinical case of mucoepidermoid carcinoma in a brown female patient aged 45 years. Results of treatment for squamous carcinoma of the lower gum. Surgery is the most common treatment for precancerous lesions lesions that havent yet developed into cancer and early cancers lesions that are cancer but havent spread.
Retromolar trigone rmt squamous cell carcinoma is uncommon but notorious for poor prognosis. However, given its proximity to the mandible and buccal mucosa, rmt scc typically exhibits early invasion and generally presents at an advanced stage. If cancer is in the retromolar trigone the small area. Determining the optimal management strategy is all the more difficult because it is a relatively uncommon tumor, and there is a paucity of data on outcomes. Cureus treatment outcomes of rare retromolar trigone. Early lesions retromolar trigone the retromolar trigone rmt is an illdefined triangular area in the oral cavity posterior to the upper and lower third molar teeth, with the maxillary tuberosity at its apex. Posterior to the retromolar trigone is the pterygomandibular raphe. Other sites include the buccal mucosa, gingiva, palate, and retromolar region. Few studies have examined the optimal treatment for this cancer. Retromolar trigone squamous cell carcinoma treated with. The aim of this study was to evaluate the outcome of treatment for primary scc of the retromolar area.
Squamous cell carcinoma of the retromolar trigone epidemiology. Basaloid squamous cell carcinoma of retromolar trigone. Most commonly, it occurs on the tongue 40% of cases and the floor of the mouth 30%. Acinic cell carcinoma of the retromolar trigone region. Imaging in squamous cell carcinoma of the retromolar trigone. Patients with deep involvement of the muscles of mastication may also complain. Retromolar trigone rmt tumors are rare and aggressive malignancies, spreading rapidly into surrounding structures. Here we report a 35yearold male referred by his dentist for evaluation of a lesion located near the retromolar trigone. Cancers arising in the retromolar trigone the narrow band of mucosa that lies behind the mandibular molars and covers the ascending ramus are rarely confined to that gingiva, but involve adjacent buccal mucosa, anterior tonsillar pillar, the floor of the mouth, andor posterior gingiva. Treatment of squamous cell carcinoma of the retromolar.
In addition to directly assigning tnm, summary stage 2000 ss2000 must be captured. R radiation therapy s surgery c chemotherapy a choice of treatments preferred modality is first a lesser therapeutic alternative. Pdf retromolar trigone carcinoma treated by primary. Local tn staging of squamous cell carcinoma scc of the rmt. Overall, the rmt is the least common site of squamous cell carcinoma scca of the oral cavity. A subcutaneous mandibulotomy approach has recently been described for large tumours of the oropharyngeal. Original article retromolar trigone carcinoma treated by. A 59yearold male was referred with a painless growth at. Early stage oral cavity cancer memorial sloan kettering. Lip and oral cavity cancer treatment can include surgery, radiation therapy, or both, and depends on the site and extent of the tumor. Early lesions are commonly t1 and t2 with negative nodes. Management of the clinically negative neck in early.
Retromolar trigone squamous cell carcinoma the fourth most common oral cavity and oropharynx malignancy 6% of cases, grouped with gingival scca due to similar history and management most telling diagnostic clue is the obliteration of buccal fat behind the parotid duct. Carcinomas originating in the retromolar trigone rmt are uncommon and characterized by early spread. Histopathological examination of the lesion showed an acinic cell carcinoma acc of minor salivary gland origin. Distant metastases are very rare, and the oral cavity metastases are exceedingly rare. Controversies in the management of retromolar trigone carcinoma. We retrospectively examined 46 patients with squamous cell carcinoma of the retromolar trigone treated primarily with radiotherapy from january 1, 1973, to june 31, 2002.915 900 771 320 677 1082 715 435 587 63 100 1600 267 605 860 1307 1483 983 387 732 747 45 823 1216 429 1379 5 873 566 3 657 403 1531 256 467 714 1 662 614 196 1220 1066 1218 307 1472 393 26 474 993 848