J Korean Assoc Oral Maxillofac Surg.  2017 Jun;43(3):191-196. 10.5125/jkaoms.2017.43.3.191.

Squamous cell carcinoma of the buccal mucosa involving the masticator space: a case report

• Kim IH
• Myoung H

• KMID: 2386366
• DOI: http://doi.org/10.5125/jkaoms.2017.43.3.191

Abstract

Squamous cell carcinoma of the buccal mucosa has an aggressive nature, as it grows rapidly and penetrates well with a high recurrence rate. If cancers originating from the buccal mucosa invade adjacent anatomical structures, surgical tumor resection becomes more challenging, thus raising specific considerations for reconstruction relative to the extent of resection. The present case describes the surgical management of a 58-year-old man who presented with persistent ulceration of the mucosal membrane and a mouth-opening limitation of 11 mm. Diagnostic imaging revealed a buccal mucosa tumor that had invaded the retroantral space upward with involvement of the anterior border of the masseter muscle by the lateral part of the tumor. In this report, we present the surgical approach we used to access the masticator space behind the maxillary sinus and discuss how to manage possible damage to Stensen's duct during resection of buccal mucosa tumors.

Keyword

Squamous cell carcinoma; Oral cavity cancer; Buccal mucosa; Stensen's duct

MeSH Terms

Carcinoma, Squamous Cell*
Diagnostic Imaging
Epithelial Cells*
Humans
Masseter Muscle
Maxillary Sinus
Membranes
Middle Aged
Mouth Mucosa*
Recurrence
Salivary Ducts
Ulcer

Figure

• 

  Fig. 1 A. Preoperative frontal view. Note the dimple on the left cheek, which raised suspicion of a subcutaneous layer invasion. B. Contrast computed tomography revealed a tumor extending into the masticator space and destructing the left maxillary sinus wall. C. Along with the buccal mucosa tumor, magnetic resonance imaging revealed a laterally extending tumor in the region (arrow) of the subcutaneous layer.

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  Fig. 2 Surgical approach and mass resection procedure. A modified Weber-Ferguson incision, without lateral extension on the maxilla combined with lower-lip splitting with mandibulotomy, was made and then a cheek flap was laterally reflected to provide sufficient exposure of the lateroposterior aspect of the maxillary sinus.

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  Fig. 3 A. A cut-down tube was inserted into the proximal stump of the severed Stensen's duct. B. Salivary secretion resumed through the tube, which was secured in the oral cavity, and clinical symptoms improved.

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  Fig. 4 Frontal view 1 month after surgery. Facial asymmetry was observed owing to the double-paddled reconstruction with a latissimus dorsi free flap, but gradual atrophy of the flap is expected. B. The maximum mouth opening measured at 1 month after surgery. Trismus was resolved. C. The patient was able to freely move his left shoulder and did not complain of discomfort at the donor site.

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