Modified Bilateral Perialar Crescent Flap for Reconstruction of Combined Upper Lip and Premaxillary Defect.

Many reconstruction methods are performed for combined defects of upper lip and premaxilla in oral cancer patients, which are complicated and multiple staged procedures, compromising the functional or structural unit. In this case report, we present a modification of the bilateral perialar crescent flap for reconstructing the combined defect of upper lip and premaxilla in a single stage. A patient diagnosed with well-differentiated squamous cell carcinoma of premaxilla and upper lip, involving a surgical defect of more than one-third but less than two-thirds of the lip underwent two cycles of neoadjuvant chemotherapy. Later wide local excision of the lesion and simultaneous reconstruction with a modified perialar crescent flap was performed in a single stage. Patient recovered uneventfully and tolerated the procedure well, without any complications. The patient was found to be satisfied with the functional and esthetic result. The reduced upper lip support which was a result of the bony defect of the premaxilla, was corrected with a dental prosthesis. This modification is a useful reconstruction tool for oral cancer patients with combined defects of upper lip and premaxilla.

Metastatic Tumour to the Mandible - A Diagnostic and Management Dilemma.

Metastatic tumours of the jaw are overlooked due to their relatively rare incidence. However, they are often the first indicators of an unknown primary malignant lesion. In this case report, we present a 68-year-old male patient with a suspected intraosseous malignancy of the mandible who was treated by a right segmental mandibulectomy. The final histopathology report was indicative of a secondary metastatic tumour. Positron emission tomography scan revealed a suspicious lesion in the right lung, which was identified as the primary tumour by biopsy using the Tru-Cut® biopsy device (MeritMedical, Jordan UT). The metastatic lesion to the oral soft tissues was easily recognized, in contrast to the jawbone metastasis. Differentiating between primary intraosseous and metastatic mandibular tumours relies on the histopathologist and the surgeon working in tandem to arrive at an early conclusive diagnosis. Knowledge of metastatic tumours to the facial bones is indispensable to a surgeon as it can often be the first indication of an unknown primary malignancy. Identification of early signs, appropriate and timely investigative procedures, coordination between pathologist and surgeon, and choosing the correct treatment modality can help prolong and improve the quality of life of the patient.