Marginal Mandibulectomy Research Articles

Clinical outcome of dental implants in vascularized fibular osteoseptocutaneous flap as onlay graft on marginal mandibulectomy patients

Clinical outcome of dental implants in vascularized fibular osteoseptocutaneous flap as onlay graft on marginal mandibulectomy patients

Squamous cell carcinoma of the retromolar trigone: Treatment outcomes

ObjectiveSquamous cell carcinoma (SCC) of the retromolar trigone is uncommon, accounting for 1.4% of all oral cancer cases in Japan. Few studies have examined the optimal treatment for this cancer. The aim of this study was to evaluate the outcome of treatment for primary SCC of the retromolar area. MethodsWe retrospectively analyzed the outcome and prognosis of 45 patients (38 men, 7 women) with SCC of the retromolar trigone who underwent treatment in our department between July 1992 and March 2011. ResultsMean age was 62.4 years. Clinical stages were: stage I (n=4, 8.9%); stage II (n=10, 22.2%); stage III (n=5, 11.1%); and stage IVa (n=26, 57.8%). Surgical resection was performed in all patients and 6 patients also received postoperative radiotherapy. Reconstructive surgery using free flaps was performed in 38 patients; postoperative complications occurred in 5 of these patients. The 3-year local control rate was 80%, and the 3-year over all survival rates for stage I, II, III, and IV disease were 100%, 80%, 40%, and 49.2%, respectively. Cause of death was the original disease in 23 cases and other diseases in 2 cases. The most common cause of death from the original disease was cervical lymph node metastasis. ConclusionThe presence of cervical lymph node metastasis was a negative prognostic factor. Marginal mandibulectomy may be selected for patients without distinct bone-marrow infiltration.

Treatment Outcomes of Rare Retromolar Trigone Squamous Cell Carcinoma Using Combined Modalities.

BackgroundRetromolar trigone squamous cell carcinoma is relatively uncommon and due to its complex anatomy has always remained a challenge in terms of loco-regional control and survival. Surgery, radiotherapy, and chemotherapy as combined modalities have been used but high recurrence rates result in poor outcome.MethodsWe have retrospectively evaluated records of 62 patients treated in Head and Neck Oncology unit of Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC), Lahore, Pakistan from 2004 to 2014 who were included based on the criteria of histopathological proven squamous cell carcinoma of retromolar trigone (RMT) treated with radical intent. Diagnostic workup for all patients involved clinical examination, imaging modalities usually magnetic resonance imaging (MRI), computerized tomography (CT), Orthopantomogram (OPG), and chest x-ray (CXR) to evaluate regional and distant metastasis, respectively. Kaplan-Meier survival curves were used to depict survival.ResultsThe study was comprised of 36 male and 26 female patients. Treatment modalities used are surgery only (n = 1), radiotherapy alone (n = 13), radiotherapy followed by surgery (n = 10), chemoradiotherapy (n = 16), induction chemotherapy followed by concurrent chemoradiotherapy (n = 19), induction chemotherapy followed by surgery, and radiotherapy (n = 2). Surgical interventions include wide local excisions (n = 6), marginal mandibulectomy (n = 4), and segmental mandibulectomy (n = 4). Surgical margins were clear in 54%, close in 38%, and involved in 8% of patients. AJCC 7th edition showed cT1 8%, cT2 22%, cT3 14%, and cT4 56% while pT1 2%, pT2 3%, and pT4 8%. During follow-up, 18% patients have come up with local recurrence, 22% showed persistent disease while 9% have presented with distant metastasis. The five-year and overall survivals are 38% and 22%, respectively.ConclusionRetromolar trigone involvement poses many vital structures at risk of involvement. Late presentation results in involvement of masticator space compromising both mouth opening and surgical outcomes. Surgery and radiotherapy have shown comparable results in disease control. Bone invasion has shown poor outcome in terms of loco-regional control and overall survival.

Retromolar Embryonal Rhabdomyosarcoma: A Case Report

Background: embryonal rhabdomyosarcoma is common of rhabdomyosarcoma, usually in 5 years old child. Approximately 28% of embryonal rhabdomyosarcomas occur in head and neck area, and 0.04% of cases occur as intra-oral tumors. Case: a 13 years old female complained of a firm and painless progressive mass in her right mandibular retromolar 6 months prior to her current medical check-up. There was a reddish 8x5 cm mass on the right posterior mandibular region. Mid face CT scan showed a well-bordered solid mass in her right oral cavity expanding to the right maxilla without bone destruction nor intracranial expansion. Incisional biopsy concluded the morphology as an embryonal rhabdomyosarcoma. Four series of neoadjuvant chemotherapy of vincristine, adriamycin, and cyclophosphamide (VAC) regimen gave partial response clinically and was followed by right marginal mandibulectomy procedure. Histopathological surgical specimen examination showed no active cancer cells. Adjuvant chemotherapy was given afterward. The result is good cosmetically and functionally. Discussion: retromolar embryonal rhabdomyosarcoma is diagnosed by physical examination of progressive and firm retromolar mass, retromolar mass with or without nearby-structures invasion radiologically, and confirmed by histopathology examination. Neoadjuvant chemotherapy showed partial response clinically. Complete tumor resection with adequate surgical margin is the key for a successful therapy. Conclusion: embryonal rhabdomyosarcoma is rare. The treatment plan and outcome are unique in every patient depending on the location of the tumor, the histological type, and the respectability. Pathological examination and CT scan play a significant role in diagnosing and making a good surgical plan. Early diagnosis and complete resection with adequate surgical margin is the key for a successful therapy.

Quality of life assessment of implant-retained overdentures and fixed metal-acrylic resin prostheses in patients with marginal mandibulectomy

Statement of problemSeveral factors affect the prosthetic outcome of patients with mandibular defects. However, it is questionable whether fixed or removable implant-supported prostheses meet the expectations and satisfaction of the patients. The perspectives of these patients are important in managing the prosthetic treatment strategies. PurposeThe purpose of this prospective clinical study was to evaluate the satisfaction and oral health-related quality of life of patients with marginal mandibulectomies with implant-retained overdentures and fixed metal-acrylic resin prostheses. Material and methodsTwenty-two participants with marginal mandibulectomies were included in the study. They completed an oral health impact profile questionnaire designed for patients with edentulism (OHIP-Edent) for the assessment of quality of life and visual analog scales (VASs) to validate their general satisfaction before treatment. Ten participants received 4 implant-retained fixed metal-acrylic resin prostheses, whereas 12 participants were treated with 2 implant-supported overdentures. Six months after delivery of their prostheses, the participants completed the OHIP-Edent questionnaire and VAS again. For the statistical analyses, Student t tests together with descriptive statistics (mean, standard deviation, frequency) were used in the 2 intergroup parameter comparisons that showed normal distribution. The Mann-Whitney U test and Kruskal-Wallis test were used for intergroup comparisons, and the Wilcoxon signed rank test was used for intragroup comparisons. ResultsCompared with pretreatment mean values, a statistically significant (P<.05) decrease in mean scores of all OHIP-Edent values and an increase in VAS scores were found in both groups. After patients were treated, their OHIP-Edent values in the group with an overdenture prosthesis were higher than those in the group with a fixed metal-acrylic resin prosthesis (P<.05). ConclusionsThese results demonstrate that implant-retained overdentures and fixed metal-acrylic resin prostheses provide better function and, thus, oral health-related quality of life for patients with marginal mandibulectomies.

Applicability of the CIELAB and CIEDE2000 Formulae for Detection of Colour Changes in Colour-Changeable Chewing Gum for Evaluating Masticatory Function.

Mastication is one of the essential stomatognathic functions and is impaired when mandibulectomy is performed for removal of head and neck lesions. The purpose of this study was to investigate the correlation between perceived chewing ability {Masticatory Score (MS)} and objective mixing ability (∆E) in patients who had undergone marginal mandibulectomy. Twenty normal dentate subjects as control group and twenty mandibulectomy patients who had undergone marginal mandibulectomy and wearing a dentomaxillary prosthesis were enrolled. Perceived chewing ability MS and objective ∆E were evaluated using a food intake questionnaire and the colour-changeable chewing gum, respectively. They were instructed to chew the gum continuously for 100 strokes on their usual side. The chewed gum was measured using the CIELAB colour space defined by a colourimeter and L, a* and b* were obtained. The change in colour of the gum after chewing was calculated using CIELAB (∆Eab) and the CIEDE2000 (∆E00) formula. The relationships of a*, ∆Eab, and ∆E00 with MS score were analyzed using the Spearman's rank correlation coefficient. A correlation was found between perceived chewing ability (MS) and objective mixing ability (index of the masticatory function {∆E}) in marginal mandibulectomy patients. (∆E00 = 0.481, a* = 0.587, ∆Eab = 0.668). Within the limitations of this study, it can be concluded that the CIEDE2000 formula for calculation of colour difference can be used to evaluate masticatory function in patients who have undergone marginal mandibulectomy.

Influence of bone invasion on outcomes after marginal mandibulectomy in squamous cell carcinoma of the oral cavity

IntroductionMarginal mandibulectomy (MM) is indicated for oral cavity squamous cell carcinomas (OCSCC) that abut or minimally erode the mandible without gross invasion. Successful implementation of MM is predicated on accurate patient selection and appropriate adjuvant treatment based on well-known host and tumor characteristics. The incidence of microscopically diagnosed bone involvement in MM specimens and its implications on outcomes have however not been reported in large contemporary series. PurposeTo report the incidence of bone involvement and analyze its influence on oncologic outcomes in selected patients who underwent MM in treatment of OCSCC. MethodA retrospective cohort study was performed on a consecutive series of previously untreated patients requiring MM, at a tertiary care cancer center, between 1985 and 2012 (n = 326). The median age was 64 years and 59% were male. The majority of patients (67%) had a primary tumor of the floor of the mouth or lower alveolus, 80% were clinically staged T1-2, and 31% were clinically N+. Postoperative radiation (PORT) was used in 27% and chemoradiation (POCTRT) in 8% of patients who had microscopic bone invasion. The median follow up period was 55 months and endpoints of interest were local and regional recurrence free (LRFS and RRFS) and disease specific (DSS) survival. ResultsMicroscopic bone invasion was present in 15% of patients (n = 49). Among these, cortical invasion was present in 32, medullary in 13, and it was not specified in 4. Eight patients had microscopic positive bone margins. Positive bone margins were associated with medullary bone involvement (p < 0.001), floor of mouth and buccal mucosa primary site (p = 0.03), and positive soft tissue margins (p = 0.06). LRFS and DSS were similar in patients without versus with bone invasion (62.8% vs 79.7% and 76.2% vs 66% respectively, p = NS). LRFS were similar in patients with microscopic positive versus negative bone margins, as long as postoperative adjuvant treatment was administered. ConclusionMicroscopic bone involvement does not adversely influence outcomes but medullary bone involvement does confer a higher risk of positive bone margins. MM and appropriate adjuvant treatment is an effective strategy for treatment of OCSCC in selected patients with primary tumors adherent to or in proximity to the mandible.

The Possible Role of Dental Implants in the Etiology and Prognosis of Osteomyelitis: A Retrospective Study.

The aim of this study was to describe the clinical outcome of osteomyelitis of the mandible or maxilla following dental implants. A detailed treatment protocol is also proposed. Electronic data of all the patients who were treated between October 2009 and November 2014, in three maxillofacial surgical departments, were reviewed. Computed databases were searched for the diagnosis of osteomyelitis of the mandible or maxillas (ICD9 code 526.2), and medical files were analyzed. Treatment outcome was considered successful if only primary treatment (debridement and antibiotic therapy) was applied. Statistical analysis was performed to compare treatment outcomes in the different etiologic groups. The cohort included 29 men and 25 women, with histologically and clinically proven osteomyelitis. The mean age was 59 years (range, 24 to 70 years). Forty patients had complete remission, as opposed to 14 patients who failed the primary treatment and required a more aggressive surgical intervention (11 had segmental mandibulectomy, 2 patients had marginal mandibulectomy, and 1 patient had maxillectomy). Most failures were in the dental implantation group. A previous dental implant was an independent factor for primary treatment failure and the need for aggressive surgical intervention (P = .0001). The results of this retrospective study suggest that a previous dental implant is an independent predictive factor of failure in primary treatment in osteomyelitis of the mandible or maxilla. Also, dental implant-induced osteomyelitis is a rare pathology, but it presents an aggressive subtype of osteomyelitis, and requires a broader and more comprehensive management.

Success of dental implants in vascularised fibular osteoseptocutaneous flaps used as onlay grafts after marginal mandibulectomy

We have evaluated the survival of dental implants placed in vascularised fibular flap onlay grafts placed over marginal mandibulectomies and the effects on marginal bone loss of different types of soft tissue around implants under functional loading. From 2001-2009 we studied a total of 11 patients (1 woman and10 men), three of whom had had ameloblastoma and eight who had had squamous cell carcinomas resected. A total of 38 dental implants were placed either at the time of transfer of the vascularised fibular ostoseptocutaneous flaps (nine patients with 30 implants) or secondarily (two patients with eight implants). Four patients were given palatal mucosal grafts to replace intraoral skin flaps around the dental implants (n=13), and the other seven had the skin flaps around the dental implants thinned (n=25) at the second stage of implantation of the osteointegrated teeth. All vascularised fibular osteoseptocutaneous flaps were successfully transferred, and all implants survived a mean (range) of 73 (33-113) months after occlusal functional loading. The mean (SD) marginal bone loss was 0.5 (0.3) mm on both mesial and distal sides in patients who had palatal mucosal grafts, but 1.8 (1.6) mm, and 1.7 (1.5) mm, respectively, on the mesial and distal sides in the patients who had had thinning of their skin flaps. This difference is significant (p=0.008) with less resorption of bone in the group who had palatal mucosal grafts. Palatal mucosa around the implants helps to reduce resorption of bone after functional loading of implants.

Efficacy and Safety of Piezosurgery Device in the Surgical Treatment of Oral Cancer

Introduction: A new piezoelectric surgical device, a new system for cutting bone system, has recently been developed. It uses lowfrequency ultrasonic vibrations to shape and cut bone. Case Presentation: In this paper, we report the case of a 70-year-old woman affected by (G2, T1, M0) oral cancer treated with osteotomy performed using this piezoelectric device. The case presents the complete surgical excision of a fornix squamous cell carcinoma in which the marginal mandibulectomy was effected by a piezoelectric system. Conclusions: People who have conditions involving bone that need to be surgically removed specifically nearby soft tissues or important structures (vessels, nerves, or brain), may benefit from this device. In the oral cavity, where the presence of essential structures may hinder safe osteotomy, the piezoelectric device allows the surgeon to cut bone without damaging nerves, glands, and vessels, even when in contact with them. The presence of angled inserts is also fundamental and facilitates osteotomies in areas that are unreachable by conventional cutters and burs.

Treatment and Rehabilitation of Repetitively Recurrent Langerhans Cell Histiocytosis: A Case Report

Langerhans cell histiocytosis (LCH) is characterized by proliferation of histiocyte-like cells (Langerhans cell histiocytes) with characteristic Birbeck granules, accompanied by other inflammatory cells. Treatments of LCH include surgery, chemotherapy, and radiotherapy. One of the representative forms of chemotherapy is intralesional injection of steroids. Surgical treatment in the form of simple excision, curettage, or even ostectomy can be performed depending on the extent of involvement. Radiotherapy is suggested in case of local recurrence, or a widespread lesion. This article shows the case of repetitively recurrent LCH of a 56-year-old man who had been through surgical excision and had to have marginal mandibulectomy and radiotherapy when the disease recurred. After the first recurrence occurred, lesions involved the extensive part of the mandible causing pathologic fracture, so partial mandibular bone resection was performed from the right molar area to the left molar area followed by the excision of the surrounding infected soft tissues. The resected mandibular bone was reconstructed with a segment of fibula osteomyocutaneous free flap and overdenture prosthesis supported by osseointegrated implants.

Keratocystic odontogenic tumor arising at the mandibular ramus with an impacted tooth: a case report and mimic lesions

Objectives: To consider the biologic behaviors of keratocystic odontogenic tumors (KCOTs) andameloblastomas and dentigerous cysts.Methods: A 63-year-old Japanese man presented with swelling and discomfort in the left cheek during jaw movement. Examination revealed a multilocular lesion within the mandible extending from the left second premolar to the left mandibular ramus and coronoid process; the lesion contained a deviated impacted tooth. The tumor had expanded beyond the bone and was invading the masseter and medial pterygoid muscles. Marginal mandibulectomy with a free iliac bone graft was performed.Results: No recurrence was observed during a 7-year follow-up.Discussion: The histopathological diagnosis of the lesion showed it was a KCOT. These tumors usually grow within the bone, causing bone expansion. However, this tumor had expanded beyond the bone and invaded surrounding muscles. Thus, KCOTs can, in rare cases, manifest themselves as described here. Evaluating preoperative images and histopathological findings is important to determine the optimal treatment strategy.

Prosthetic rehabilitation of marginal mandibulectomized patient using implant-supported removable partial denture

Surgical management of oral cancer results in compromised masticatory and swallowing function which affects patient in social and psychological aspects due to reduced phonetic ability and facial deformity, thus, it is imperative to provide applicable prosthetic treatment to overcome such complications. This clinical study describes rehabilitation of a patient with squamous cell carcinoma treated with marginal mandibulectomy and implantation on preserved posterior portion of mandible to provide stability and support for subsequent denture treatment. Kennedy class IV removable partial denture has provided satisfactory results in esthetics and function. Bone level stability around implants was reported to be maintained during eight months of clinical observation. (J Korean Acad Prosthodont 2016;54:126-31)

Keratocystic odontogenic tumor arising at the mandibular ramus with an impacted tooth: a case report and mimic lesions

Objectives: To consider the biologic behaviors of keratocystic odontogenic tumors (KCOTs) andameloblastomas and dentigerous cysts.Methods: A 63-year-old Japanese man presented with swelling and discomfort in the left cheek during jaw movement. Examination revealed a multilocular lesion within the mandible extending from the left second premolar to the left mandibular ramus and coronoid process; the lesion contained a deviated impacted tooth. The tumor had expanded beyond the bone and was invading the masseter and medial pterygoid muscles. Marginal mandibulectomy with a free iliac bone graft was performed.Results: No recurrence was observed during a 7-year follow-up.Discussion: The histopathological diagnosis of the lesion showed it was a KCOT. These tumors usually grow within the bone, causing bone expansion. However, this tumor had expanded beyond the bone and invaded surrounding muscles. Thus, KCOTs can, in rare cases, manifest themselves as described here. Evaluating preoperative images and histopathological findings is important to determine the optimal treatment strategy.

Objective validity of an implant-retained overdenture with a ball attachment system after marginal mandibulectomy

Implant-retained overdentures are known to improve oral function, but the clinical impact on patients who have had mandibular resections is still debatable. We have treated 16 patients who had such resections for oral cancer and consequent loss of the alveolar ridge, with overdentures supported by osseointegrated implants and ball attachments. To quantify their functional improvement, we evaluated their maximum bite force and masticatory performance. Their function improved significantly, (from 77.5N - 365N, 371% increase in maximum bite force, p<0.001) and masticatory performance increased (from 2.5 - 7.7, 208%, p<0.0001) after the overdentures had been inserted. While individual changes in maximum bite force showed no significant correlation, those in masticatory performance correlated significantly, which suggests that the subjects with poor masticatory function are likely to benefit from retention of an implant. These results indicate that implant-retained overdentures are an effective way to rehabilitate patients after marginal mandibular resection.

Reducing Trismus After Surgery and Radiotherapy in Oral Cancer Patients: Results of Alternative Operation Versus Traditional Operation

In patients with oral cancer, trismus (maximum interincisal opening [MIO] <35mm) can develop as a result of surgery and radiotherapy. The aim of this study was to provide an alternative operation to both eradicate oral cancer and prevent postsurgical trismus. In our retrospective cohort study of oral cancer patients who underwent operations during 2010 to 2014, the predictor variable was the type of operation (alternative operation or traditional operation) and the outcome variable was MIO. All of the cases were allocated by 2 periods: the traditional operations were performed from 2010 to 2011, and the alternative operations were performed from 2011 to 2014. All patients received marginal mandibulectomy, anterolateral thigh free flap, and adjuvant radiotherapy or concurrent chemoradiotherapy. In addition to traditional marginal mandibulectomy, the alternative operation included ipsilateral coronoidectomy and myotomy of the temporalis muscle insertion, masseter muscle, and medial pterygoid muscle. MIO was measured at 10 time points. The adjusted variables included demographic data, diagnostic parameters, treatment, and response. Of the 36 male patients with oral cancer, 16 were placed in the alternative operation group (AOG; mean age, 53.5 ± 11.9years) and 20 were placed in the traditional operation group (TOG; mean age, 50.7 ± 7.1years). Regarding the outcome indicator of patient MIO, the preoperative MIO in the AOG was on average 7.5mm shorter than that in the TOG (P < .01), but it was consistently superior to the MIO in the TOG after the operation. Multivariate analysis of variance showed that patients in the AOG were more likely to have postoperative non-trismus. The alternative operation exhibited superior postoperative MIO values and similar postoperative complication rates. For the prevention of trismus, it is practical to perform the combined operation simultaneously, cutting all ipsilateral jaw closing muscles and the coronoid process and eradicating the tumor.

Does marginal mandibulectomy (rim resection) improve loco-regional control in the surgical management of floor of mouth squamous cell carcinoma?

Background: In resection of oral squamous cell carcinoma (OSCC), achieving clear resection margins is an important predictor of loco-regional control and survival. Marginal mandibulectomy has been adopted by some surgeons to improve marginal clearance in the treatment of floor of mouth (FOM) tumours.

Relationships between perceived chewing ability, objective masticatory function and oral health-related quality of life in mandibulectomy or glossectomy patients with a dento-maxillary prosthesis

PurposeThis preliminary study examined whether the type of surgery performed for head and neck lesion was associated perceived chewing ability, objective masticatory function, and oral health-related quality of life (OHRQoL) in patients who required a dento-maxillary prosthesis postoperatively. MethodsThirty-eight patients with a dento-maxillary prosthesis were divided into three groups according to the type of surgery received: marginal mandibulectomy, segmental mandibulectomy with bony reconstruction, or glossectomy. Perceived chewing ability, objective mixing ability, and OHRQoL were evaluated using a food intake questionnaire, color-changeable chewing gum, and the Geriatric Oral Health Assessment Index (GOHAI), respectively. Differences in the scores obtained by the three measures were compared between the surgical groups using the Kruskal–Wallis test, and associations between the scores in each group were analyzed by Spearman's rank correlation analysis. ResultsObjective mixing ability was found to be significantly low only in patients who underwent glossectomy. No other measures differed significantly between the surgical groups. Perceived chewing ability and objective mixing ability were significantly associated in the marginal mandibulectomy and glossectomy groups but not in the segmental mandibulectomy group. Furthermore, GOHAI score was significantly associated with perceived chewing ability and objective mixing ability in the marginal mandibulectomy group. ConclusionsWithin the limitations of this study, the present findings suggest that the type of surgery received might influence food mixing ability. Associations among food mixing ability, perceived chewing and OHRQoL are not accountable depending on the type of surgery received, indicating the presence of other contributing factors to be considered.

Dental implant treatment in a young woman after marginal mandibulectomy for treatment of mandibular gingival carcinoma: a case report.

Dental implants play an important role in postoperative rehabilitation after surgical treatment of oral cancer through the provision of prosthetic tooth replacement. Two major implant prosthesis designs are available: fixed implant-supported prostheses and implant-supported overdentures. We herein report a case of a 16-year-old female patient who underwent alveolar ridge resection for treatment of mandibular gingival carcinoma. Following surgery, oral rehabilitation was attempted using an implant-supported overdenture on a gold bar retainer splinting four implants. However, the patient was not satisfied with this prosthesis because of mucosal pain and discomfort, and she gradually ceased its use. Consequently, contact with the opposing teeth caused wear of the prosthetic screws. We elected to replace the implant-supported overdenture with an implant-fixed prosthesis approximately 16 years after insertion of the overdenture to prevent further wear of the prosthetic screws. The patient was highly satisfied with the improved stability of the implant-fixed prosthesis. This case report indicates that the clinician must occasionally re-evaluate and sometimes alter the direction of treatment, even after definitive therapy has been completed.

A Presentation of Multiple Primary Squamous Cell Carcinoma in the Oral Cavity

Multiple primary oral squamous cell carcinomas (SCCs) are uncommon in clinical practice. In this report, we describe 3 synchronous SCCs. A 65-year-old female non-smoker was referred to our facility for evaluation of a SCC on the soft palate. Intraoral examination revealed 2 other erythematous lesions (on the border of the tongue and lower gingiva). Erythroplakia and SCCs were suspected. Incisional biopsies were performed, and the diagnosis was SCC in both lesions. The treatment consisted of anterior marginal mandibulectomy; left partial glossectomy; and hard and soft palate resection with skin free flap reconstruction. In addition, the patient was referred for adjuvant radiotherapy. This case shows a complete diagnosis performed by stomatologists, which led to appropriate treatment.