case_images: PMC8783314_01
case_images: A) intra operative picture showing right bite composite resection involving hemimandible and maxillary alveolectomy till pterygoid plates, with right side selective neck dissection; B) post-operative radiograph of the mandible after bite composite resection (PA view); C) intra operative photograph of pectoralis major myocutaneous (PMM) flap; D) intra operative picture showing no leak of the chyle fluid; E) chest X-ray taken on post-operative day 7 to rule out pleuritis or pleural tear
case_images: PAMJ-40-209-g001.jpg
case_images: PMC8783314_01_PAMJ-40-209-g001.jpg
case_images: F1
case_images: Clinical findings: on thorough examination there was diffuse swelling present on right side of face over lower jaw, mouth opening was restricted and ulceroproliferative growth was seen in right buccal mucosa involving gingivo-buccal sulcus extending to lingual mucosa, edges were everted, lymphadenopathy-submandibular lymph node was palpable and enlarged (0.5 * 1 cm approx), with right side selective neck dissection (Figure 1A and B) level I-III followed by reconstruction with right side pectoralis major myofascial flap (Figure 1C). The intraoperative procedure went uneventful, IJV was preserved and the patient was asked to forcefully breathe out (expiration) against a closed glottis which revealed no incidence of chyle leak intra operatively before closure (Figure 1D). Two drains were secured in neck and chest and patient was shifted in surgical ICU for further monitoring and recording (Figure 1E).