PMC9326202_01
Preoperative pictures (from right top to down). (a and b) Extraoral clinical picture showing skin induration, (c) Intraoral picture of ulceroinfiltrative lesion involving floor of the mouth and lower alveolus, (d) Orthopantomogram, (e) CECT scan of the head and neck with axial and sagittal view
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F1
On clinical examination, a ulceroinfiltrative lesion present in the lower alveolus with involvement of gingivobuccal sulcus from either side of the canine, floor of the mouth with subcutaneous skin involvement of submental region and no significant neck nodes in the neck [Figure 1a-c]. On radiological examination, contrast-enhanced computed tomography of the head and neck was taken, and it reveals ill-defined heterogeneous lesion with anterior mandibular bone erosion, involving mylohyoid muscle and loss of fat planes were noted in the submental region. Orthopantogram (OPG) reveals ill-defined radiolucency from left canine to right canine region, which is illustrating with a destructive lesion and floating tooth on the left side of the mandible [Figure 1c and d].
Intra operative pictures (from right top to down). (a) Incision marking and (b) post excision defect, (c) harvestment of nonvascularized bone graft of fibula of 6.5 cm from left leg (d) closure of donor site with drain, (e and f) Specimen picture of full thickness wide excision of skin of chin with anterior segmental mandibulectomy and floor of the mouth with adequate margin
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F2
The patient was treated with composite resection (full-thickness wide excision of anterior mandible from first premolar on either side of the mandible as segmental mandibulectomy + floor of mouth excision), bilateral comprehensive neck dissection [Figure 2a-f].
(a and b) Postoperative pictures. (c and d) 1 month postoperative intraoral picture, (e) 3 month postoperative intra oral picture, (f) 3 month postoperative orthopantomogram, (g) 3 month postoperative anteroposterior and lateral view radiograph of the left leg
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F3
Reconstruction was done with harvestment of nonvascularized bone grafts (NVBGs) fibula from the left leg measuring 6.5 cm, and fixation was done with 1-2 mm (4 hole) plates in the right side, 1-2 mm (2 hole) plates in the left side, and 6 numbers of 2 mm x 8 mm long screws [Figure 3a-e]. On the 1st and 3rd month postoperative follow-up, OPG was revealed good bone formation in the left side as compared to the right side [Figure 3f] and donor site of fibula region shows no abnormalities other than bone harvest defect [Figure 3g].