Squamous cell carcinoma of the cheek as a result of chronic khat abuse

Anamnesis:

A 30-year-old male from India presented with lockjar, dysphagia and night sweats. Clinical examination showed an extensive tumor of the right cheek infiltrating the vestibular fold as well as the ascending lower jawbranch and pterygopalatine fossa.

Therapy:

The tumor was resected performing a partial maxillectomy, partial mandibulectomy and a total parotidectomy via righthanded hinge flap. Surgery was completed by a bilateral neck dissection, tracheostomy and defect coverage using a latissimus dorsi flap. Since the biopsy showed an oral squamous cell carcinoma (pT4a, pN0(0/44), cM0, L1, V0, Pn0, R0), an adjuvant chemoradiation using cisplatin followed.

Course of events:

The first restaging showed recurrence in the cheek and maxilla as well as local radioosteonecrosis indicating a hemimaxillectomy, extended partial mandibulectomy and revision of the neck dissection on the right side. The defect was covered with a pectoralis major flap. Due to wound healing disorder and subsequent necrosis of yet another soft tissue, reconstruction using a deltoid flap, eventually, an epithesis was adapted. The case was presented in our interdisciplinary tumor board after restaging revealed a new local recurrence infiltrating the nasal septum. Since surgically curative treatment was no longer possible, a palliative chemotherapy according to the EXTREME-protocol was indicated.

Discussion:

Our patient reported an abuse of khat (Catha edulis), which releases amphetamines when being chewed. However, its long-term consumption is associated with developing oral carcinomas which are considered to be one of the most common malignancies in India. Adaptation of an epithesis can enable rehabilitation if methods of plastic surgery fail.

Publikationsverlauf

Publikationsdatum:
23. April 2019 (online)