TRIGGER WARNING: SENSITIVE CONTENT || Managing Multiple Dental Extractions in a Patient with Advanced Squamous Cell Carcinoma

Before I begin, I need an opinion guys. Do you think the cases I post might be a bit too much sometimes? I have friends who sometimes feel grossed out by my cases but that's the reason why I always post a trigger warning and try to blur the cover picture as well. I will do that in this post as well but if you're really interested in reading about interesting surgical cases with good knowledge as well, then this post is for you.

A 38-year-old male patient presented with advanced squamous cell carcinoma affecting the left side of his face. This aggressive form of cancer had caused extensive destruction of tissues, including severe muscle, soft tissue, and bone loss, leading to significant facial deformity. The patient was suffering from intense pain due to his teeth in the affected region, and immediate dental intervention was required to alleviate his discomfort. The patient was referred to us by the Plastic Surgeon.

This case presented significant challenges. The carcinoma had invaded the surrounding soft tissues, reducing their integrity and strength, while the exposed bone was fragile and prone to complications.

Before we move on let me brief you guys regarding Squamous Cell Carcinoma.

Squamous cell carcinoma (SCC) is a type of skin and tissue cancer that develops in the squamous cells, which make up the outer layers of skin and line organs like the mouth, throat, and lungs. These cells are prone to damage from prolonged exposure to harmful agents, including ultraviolet (UV) radiation, tobacco, alcohol, or chemical irritants. Over time, this damage can cause the cells to grow abnormally and form cancer.

In the early stages, SCC may present as sores, lesions, or lumps. However, if left untreated, it can invade deeper tissues, causing extensive damage and even spreading to other parts of the body. In this patient’s case, SCC had advanced to an aggressive stage, destroying not only the soft tissues but also portions of the underlying bone and jaw structure, making a routine dental procedure for me like tooth extraction a highly complicated process.

The primary goal was to extract the teeth causing the patient severe pain while minimizing complications. This was easier said than done, given the condition of the patient’s tissues. The cancer had compromised the blood supply in the affected region, making healing slower and increasing the risk of post-operative infection. Additionally, the presence of necrotic (dead) tissue around the extraction site added another layer of complexity.

Local anesthesia which is also known as the infiltrate was carefully administered, ensuring that it was effective without causing further trauma to the necrotic tissues. The teeth were extracted using atraumatic techniques, minimizing the risk of fracturing the fragile jawbone or damaging adjacent tissue.

One of the most significant concerns was the risk of osteonecrosis, a condition where the bone tissue dies due to a lack of blood supply. To control this risk, post-operative care was emphasized.

Post-Operative Care and Multidisciplinary Approach
After the procedure, the patient was closely monitored for signs of infection, excessive bleeding, and worsening necrosis. Antibiotics and analgesics were prescribed to manage infection risks and provide pain relief. The care plan included wound management and pressure packing to ensure proper healing.

I cannot emphasize enough the importance of taking good care of your health and hygiene. Every single day, I come across cases where patients are teetering on the edge of losing their lives, and it’s both heartbreaking and frustrating. It’s devastating to witness individuals in such dire situations, begging for another chance at life—often because of preventable issues. Maintaining proper hygiene, eating nutritious food, exercising regularly, and attending to minor health concerns before they escalate can make all the difference. Your body is your most valuable asset, and neglecting it can have catastrophic consequences. Please prioritize your well-being and take proactive steps to lead a healthier, longer, and happier life.

I have another interesting case to share but I'll do that in a separate post.

Dr Huzaifa Naveed