A 49-year-old male patient underwent extraction of a third molar into a fourth quadrant and curettage of a large tissue at apical and distal level of the tooth.
The only personal history of interest is to highlight a smoking habit of 35ppaq.-year and an alcohol consumption of 150g/d.
As for family history highlights the death of his father for colon cancer.
The symptoms on physical examination were pain and inflammation in a region of 48 of several months of evolution that did not improve after extraction, also presenting a vestibular consistency of the fourth quadrant physical examination normal mucosa and upper quadrant.
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After analyzing the tissue extracted during tooth 48 extraction by the Pathological Anatomy Service, it is reported as Characterization Squamous with well differentiated cells.
A general extension study was carried out to determine clinical manifestations at head and neck level, where no neoformative destructive lesion was found in computerized tomography affecting the body and mandibular ramus and multiple cervical lymph nodes right distance.
The case is discussed in the Head and Neck Functional Unit (HCU) with chemotherapy and is catalogued as a T2N2bM0 and it is decided a radical surgical treatment together with a concomitant radiotherapy fields.
A segmental mandibulectomy is performed from tooth 43 to the right subcondylar region, modified radical cervical lymph node dissection, temporary colostomy and reconstruction by microvascular osteomyocutaneous graft.
Pathological anatomy classifies Squamous keratinizing carcinoma and affectation of 23 of the 35 nodes removed with extra invasion of the same nodes classified as pT2pN2
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3.5 months after surgery recurrence was observed after performing a new cervical CT for the appearance of cervical tumors compatible with massive recurrence in the form of multiple bilateral adenopathies.
We discuss the possibility of performing a new cycle of chemotherapy but it is discarded due to rapid massive recurrence, lack of response to treatment and low level of tolerance to chemotherapy by the patient.
The patient died 6.5 months after surgery due to local recurrence.
