PMC5153464_01
(a) Extraoral draining sinus. (b) Bells sign positive with absence of wrinkles on the affected side of the forehead. (c) Erosive ulcer extending from the corner of the mouth to retromolar trigone. (d) Diffuse widening of the mandibular canal extending from the mandibular foramen to the mental foramen. (e) Axial CT scan showing widening of the mandibular canal. (f) 10x view showing extensive PNI with the presence of tumour cells in the form of islands approximating the neural tissue. (g) 40x view showing intraneural tissue intermixed with tumour islands.
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He presented with a six-month history of nonhealing ulcer in the right side of the buccal mucosa with an extraoral draining sinus and dysphagia for one month (Figure 1(a)). Extraoral examination confirmed the classical signs of lower motor neuron type facial nerve palsy which included absence of wrinkles on the forehead, lagophthalmos of the right eye positive bells sign, flattening of the nasolabial fold, and deviation of the angle of the mouth on smile to the left side (Figure 1(b)). On palpation, there was induration, tenderness, and the presence of fibrous bands (Figure 1(c)). The panoramic radiograph revealed the presence of generalized bone loss with diffuse uniform enlargement of the mandibular canal, starting from the mandibular foramen to the mental foramen (Figure 1(d)). No breach in the cortical plates was seen (Figure 1(e)).