Treatment experience of maxillary gingival cancer with simultaneous carotid endarterectomy for internal carotid artery stenosis

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  • YAMADA Ryuhei
    Department of Oral and Maxillofacial Surgery, Osaka General Medical Center
  • ISHIHARA Osamu
    Department of Oral and Maxillofacial Surgery, Osaka General Medical Center
  • CHIDA Tadashi
    Department of Oral and Maxillofacial Surgery, Osaka General Medical Center
  • TANIGUCHI Hiroki
    Department of Oral and Maxillofacial Surgery, Osaka General Medical Center

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  • 内頸動脈狭窄症に対する頸動脈内膜剥離術を同時に行った上顎歯肉癌の治療経験
  • ナイ ケイドウミャク キョウサクショウ ニ タイスル ケイドウミャク ナイマク ハクリジュツ オ ドウジ ニ イッタ ジョウガク シニクガン ノ チリョウ ケイケン

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Abstract

<p>We report the experience of treating maxillary gingival cancer with simultaneous carotid endarterectomy for internal carotid artery stenosis. A 72-year-old man was referred to our department with complaints of pain in the left maxillary gingiva. An ulcer lesion with clear demarcation of about 30 × 25mm was observed in the left maxillary gingiva. A biopsy revealed a diagnosis of moderately differentiated squamous cell carcinoma. Preoperative examination revealed a complication of internal carotid artery stenosis. The preoperative diagnosis was maxillary gingival carcinoma (cT4aN0M0) and internal carotid artery stenosis. The internal carotid artery had 90% stenosis and required early treatment. In consultation with neurosurgery, it was suggested that if perioperative management was performed with careful attention to blood pressure control after CEA, simultaneous surgery for oral and maxillofacial surgery would be possible. Thus a tracheotomy was performed under general anesthesia, then, following CEA, left neck dissection, parapharyngeal dissection, lateral pharyngeal lymphadenectomy, partial maxillary resection, and an oral reconstruction using the anterolateral thigh flap were performed. The next day, external jugular vein thrombus at the anastomotic site was confirmed, and reanastomosis was performed. There were no complications such as perioperative cerebral infarction. Four years after the operation, neither progression of vascular restenosis nor tumor recurrence have been observed.</p>

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