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This case report presents the endodontic and prosthodontic management of a rhinectomy patient who sustained iatrogenic damage to the apices of her anterior maxillary teeth during surgical resection of a nasal tumour. We discuss the issues with surgical and prosthodontic management of oncology patients who have undergone surgery and radiotherapy, in addition to the endodontic techniques employed to ensure success of treatment whilst noting important prognostic indicators. The case highlights the importance of routine radiographic review and post-surgical tooth assessment of patients who sustain trauma or have surgery in the midface, since clinicians may only radiograph anterior teeth when they are symptomatic and/or present with trauma.
CPD/Clinical Relevance: Close monitoring of traumatized teeth or teeth in close proximity to surgical sites should be provided.
Article
The present case report discusses a 46-year-old female who presented to the restorative department at Liverpool University Dental Hospital in July 2019, following referral from oral and maxillofacial surgery colleagues, for the management of her maxillary anterior teeth. Her complaints were of discomfort related to UR3. There was no history of swelling or infection related to the teeth. She had a history of squamous cell carcinoma of the nasal cavity, which was treated with total rhinectomy, primary horizontal zygomatic implant placement and post-operative radiotherapy, completed in July 2019. She had a zygomatic implant-retained nasal prosthesis that was functioning well (Figures 1 and 2). Her medical history was otherwise unremarkable. The patient experienced xerostomia as a result of radiotherapy to the head and neck region.
Intra-oral clinical examination revealed a partially dentate individual with loss of posterior support. The patient demonstrated periodontal disease resistance and good clinical attachment levels. No teeth were found to be tender to percussion or mobile beyond physiological tooth mobility; however, there was slight fremitus found associated with UR1, UR2 and UL1 and the patient had a feeling of numbness (suggesting the area ‘feels dead’) to palpation over the anterior gingivae. UL2 was fractured coronally and was found to be unrestorable.
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