CASE PRESENTATION

CASE I
• 46 yr old male with no co-morbidities ,with h/o addiction to tobacco chewing
(Gutka) had come with complaints of non healing ulcer since 6 months. It was
gradual in onset and progressive in nature

• On examination ,there was complete trismus

• CT scan(July 2022) showed mass lesion in the region of buccal mucosa

extending into inferior gingivobuccal sulcus.No mandibular bone erosion
prsent.Posterioly shows ill defined fat planes with masseter muscle.

• Biopsy -SCC
• In view of locally advanced nature of disease , patient was planned for
radical chemoradiation treatment
• He received 70Gy/35# along with 6 cyles of concurrent inj Cisplatin
(last on13/8/22)
• Now patient came with complaints drooping of right eyelid and double
vision since 2 weeks, which was gradual in onset and progressive in
nature
• On examination , Right eye complete ptosis present and right pupil
placed inwards and medially (LR palsy)
• PET CT (Nov 2022):Metabolically active soft tissue lesion is seen in th right buccal
mucosa region involving lower GB sulcus extending laterally upto the overlying
skin(2.9x 1.6cm , suv-8.9) and abuting te mandible.Mild soft tissue thickening with
heterogenous tracer uptake noted in the right retromolar trgone region

• MRI(nov 2022):As compared to previous CT (June 2022), there is significant reduction

in size of lesion .Lesion -2.9x 2.1cm is seen in the right buccal space along the body of
mandible. It is involving the inferior GBS.Posteriorly invlovinng the adjacent part of
right masseter muscle.Medially involvinthe adjacent part of the right sub mandibular
gland,laterally reaching upto skin.There was increased enhancement present in the right
cavernous sinus region(new finding)
• Neurosurgery opinion was sought and was planned for palliative
chemotherapy
• Patient at present planned for paclitoxol and cisplatin 3 weekly
chemotherapy