Microinvasion: A Clinical Dilemma

Microinvasive oral squamous cell carcinoma (MIOSCC) is an early stage malignant tumour,showing invasion of the epithelial cells confined to the superficial lamina propria. This is matter of debate in respect to the clinical presentation, metastasis, therapeutic intervention and prognosis. A 32-year female reported to the department with chief complaint of wound and burning sensation in her left back region of lower gums. Clinical diagnosis of erosive oral lichen planus was made and topical steroid was started. The lesion clinically healed with the use of topical medicine. After stopping the medication the lesion recurred, following which, excisional biopsy was done. On histopathological evaluation diagnosis of microinvasive oral squamous cell carcinoma was made. Recurrence of similar symptom in the same site was seen 10 weeks later, which now showed features of moderate dysplasia. Clinical features of microinvasive oral squamous cell carcinoma resembles premalignant lesion, leading to difficulty in diagnosis, treatment and prognostic assessment. Thus, adequate representation of this entity is necessary.

Even a Tooth Slips Sometimes

While impaction of a tooth or two in dentoalveolar region is common, ectopic presence of them in non-dentate area is less commonly reported. A 45-year-old female reported to the department with pain on right back teeth region since two days. On examination, grossly decayed 46, root stump 47, missing 48, with poor periodontal status were noted. Panoramic radiograph was advised for screening, which revealed an inverted impacted 48 at the right ramus just below subcondylar region. However, it was an incidental finding and the patient was asymptomatic, she was informed about the pros and the cons of her case and kept under close monitoring.