An alternative method for reconstructing anterior segmental mandibulectomy defects with a plate and pectoral major muscle flap

Background: Reconstruction of anterior segmental mandibulectomy still remains a challenge. Osteocutaneous free flap remains the ideal choice of reconstruction because it restores cosmesis and function. The use of other locoregional flaps compromises cosmesis and function. Here, we have introduced a unique technique of reconstruction with lingual cortex mandibular plate as an alternate choice for free flap. Method: Six patients aged 12–62 years underwent oncological resection for oral cancer which involved the anterior segment of the mandible. Following resection, they underwent lingual cortex mandibular plating with pectoralis major myocutaneous flap reconstruction. Adjuvant radiotherapy was delivered to all patients. Results: The mean bony defect was 9.2 cm. There were no significant perioperative events related to the surgery. None required tracheostomy and all were safely extubated with no post-surgical complications. The cosmetic and functional outcomes were acceptable. Following the completion of radiotherapy with a median follow-up of 11 months, Plate exposure occurred in one patient. Conclusion: The technique is cheap, quick and simple, and can be effectively applied in resource-constrained and demanding situations. It is possible to consider this as an alternative treatment strategy for osteocutaneous free flap in anterior segmental defects

Diagnostic Dilemma For An Unusual Presentation Of Thyroid Malignancy

Diagnosis is a crucial element for prompt identification and treatment of serious diseases. Thyroid malignancy presenting as brain metastasis is a rare entity while presenting as colon metastasis is extremely rare. Here, we discuss the difficulty faced with the diagnosis of the same. We report the case of a 66-year-old male, who was a known diabetic and hypertensive and presented with the complaint of the right facial nerve weakness. On evaluation, he was found to have an extradural lesion in the right petrous bone. He underwent pre/retrosigmoid craniotomy and subtotal decompression of lesion. Histopathology showed metastatic adenocarcinoma. He underwent positron emission tomography/computed tomography scan, which showed metabolically active foci in the posterior cranial fossa, ascending colon, manubrium sterni, and lung. Colonoscopy demonstrated a polyp in the ascending colon, biopsy of which revealed metastasis from the thyroid. Later, he was found to have a nodule of 1 cm in the right lobe of thyroid. Total thyroidectomy was done and the histopathology showed a multifocal papillary carcinoma thyroid follicular variant with tall cell areas and capsular invasion.