case_images: PMC9078855_01
case_images: Photographs of a large right-sided facial necrotizing mass causing facial disfigurement after successive treatment. (a) Initial presentation. (b) After reconstruction of first tumour debulking with cutaneous allograft. (c) After reconstruction of the second debulking with split-thickness skin graft.
case_images: CRIRA2022-2953579.001.jpg
case_images: PMC9078855_01_CRIRA2022-2953579.001.jpg
case_images: fig1
case_images: The patient's right ear was displaced superiorly while his mouth was deviated to the left (Figure 1(a)). The tumour debulking included the excision of the right ear and was restored by means of a transposition flap of the masseter muscle to cover the buccal communication (Figure 1(b)). A second reconstruction using a split-thickness skin graft from the right thigh was used to cover the remaining defect after two weeks of granulation of the original wound bed (Figure 1(c)).
case_images: Axial MRI of the head showing a large lobulated mass centered at the right preauricular region. (a) The lesion appearing hypointense on T1-weighted imaging, (b) moderately hyperintense on T2-weighted imaging, and (c) showing marked homogeneous contrast enhancement with peripheral and intratumoral zones of necrosis (white arrows) on T1-weighted imaging after gadolinium administration. The masseter muscle and perioral muscles are not separately visible due to deep muscular invasion. There is also deep invasion of the tumour behind the right mandibular ramus in the masticator space.
case_images: CRIRA2022-2953579.002.jpg
case_images: PMC9078855_01_CRIRA2022-2953579.002.jpg
case_images: fig2
case_images: T1-weighted imaging and moderately hyperintense on T2-weighted imaging and showed marked homogeneous contrast enhancement with peripheral zones of necrosis (Figures 2(a)-2(c)). The adjacent right masseter muscle, medial and lateral pterygoid muscles, and the perioral muscles were not separately visible due to deep muscular invasion.
case_images: Axial MRI of the head showing postoperative outcome by after the first stage of debulking with a drastic reduction in tumour tissue (red star). (a) T2-weighted imaging, (b) T1-weighted imaging, and (c) T1-weighted imaging after gadolinium injection. The masticator muscles show increased T2w intensity and diffuse enhancement, due to muscle oedema (yellow arrow). Residual tumour tissue is difficult to differentiate for which follow-up imaging is necessary.
case_images: CRIRA2022-2953579.003.jpg
case_images: PMC9078855_01_CRIRA2022-2953579.003.jpg
case_images: fig3
case_images: Given the tumour's massive size and proximity to important structures, the patient underwent a debulking excisional surgery, a mass of 2.8 kg tumorous tissue was removed in total (Figure 3).