Critical Cases
67 years old female suffering from right breast advance carcinoma.Lump was in inner and lower quadrant of the breast .size of lump was 8cm *7 cm.it was adherent with pectoralis muscle.Right modified radical mastectomy with reconstruction with right LD flape was done.
42 years old male suffering from right buccal mucosa carcinoma involving maxilla.patient was
given radiation with chemo before 3 months.pet ct shows disease is localised to right cheek
with maxilla and mandible.Disease was reaching up to supra notch .Right modified neck
dissection with right hemimandibulectomy with right lower partial maxillectomy with bilobe
pectoralis flape was done.
70 years old female suffering from right breast
upper and outer quadrant mass since 15 days.FNAC
shows carcinoma breast.further investigation
shows multiple pulmonary mestatic lesion.To do
further systematic chemotherapy wide excision of
lump was done to know the hormonal status.
75 years old female suffering from left breast
mass since 3months.mass was involving outer
breast skin.multiple lymph nodes were in
axilla.patient has left pleural effusion and it
shows non malignant.right modified mastectomy
with primary closure done.
36 years old male suffering from lower Gb sulcus
carcinoma.CT scan shows involvement of
lower alveolus with left neck nodes.left
modified neck dissection with central arch
marginal
mandibulectomy with lower Gb sulcus growth
excision with bilateral nasolabial flape done.
65 years old male suffering from lower Gb sulcus
carcinoma involving lower mandible central
arch.patient was operated for right buccal
mucosa carcinoma before 3 years.left modified
neck dissection with left lower marginal
mandibulectomy with pectoralis flap done.
70 years old female suffering from left breast
outer and lower quadrant mass infiltrating to
skin
Left modified radical mastectomy with primary
closure done.
70 years old male suffering from left lateral
margin tongue carcinoma.patient having
diabetes ,hypertension with human immuno
deficiency virus since 10 years.After assessing
left modified neck dissection with wide excision
of left lateral margin tongue growth with
primary closure done.
40 years old male suffering from right buccal
mucosa carcinoma involving lower GB sulcus.CT
scan shows growth involving lower GB
sulcus.Right modified neck dissection with right
segmental mandibulectomy with right PM flape
done.
37 years old male suffering from right buccal
mucosa carcinoma involving upper and lower GB
sulcus and having big submandibular mass with
involvement of right external cheek skin.Right
modified neck dissection with right
hemimandibulectomy with upper alveolectomy with
excision
of external cheek skin with bilobe PM flape
done.
57 years old male suffering from carcinoma left
pyriform fossa carcinoma involving lateral
pharyngeal wall.patient is diabetic and
hypertensive.Laryngectomy with pharyngectomy
with
left PM flape for patch pharyngoplasty was done.
55 years old male suffering from left tongue
carcinoma since 2 months.patient was operated
for left lower Gb sulcus verrucous carcinoma in
2012 and operated for left buccal mucosa
carcinoma in 2022 with free radial forearm flape
with post op RT plus CT.Today left Ant 2/3
and post 1/3 lateral margin tongue growth
excision with pectoralis flape done.
33 years old male suffering from left retromolar
trigone growth extending in to upper GB
sulcus.pt has retraction of overlying cheek
skin.CT scan shows erosion of upper alveolus.
Left modified neck dissection with left distal
segmental mandibulectomy with left upper
alveolectomy with bilobe PM flape done.
50 years old male having upper FB sulcus
carcinoma since 30 days .oatient was operated
for
lower GB sulcus carcinoma before 18 months at
other place.At that time left segmental
mandibulectomy with free fibular graft was
done.post op radiotherapy was given.after that
pt
develope upper Gb sulcus carcinoma .Left lower
partial maxillectomy with primary STG with
dental prosthesis was kept.pet ct shows lesion
in upper left palate only.
48 years old male having right lower
gingivobucxal carcinoma before 4 years .pt was
operated
and post op radiotherapy given.before 15 days is
having right soft palate ulcer which shows
carcinoma .wide excision with right lateral
tongue flape done.
49 years old male suffering from right soft
palate and right poterolateral pharyngeal
carcinoma.Pt was operated for right tongue
carcinoma before 4 years.right lower partial
maxillectomy with posterior pharyngeal growth
excision with reconstruction with right
temporalis muscle done.
42 years old male suffering from right lower FB
sulcus growth involving alveolar margin and
outer lip skin.patient was operated for left
buccal mucosa growth before 3 years .It was T1
lesion .patient was kept under observation
.right modified neck dissection with right
marginal mandibulectomy with right Pectoralis
flape was done.
49 years old male suffering from left lateral
margin tongue carcinoma.left SOHND with wide
excision of left tongue growth with primary
closure done.
34 years old male suffering from left anterior
2/3 tongue carcinoma crossing midline.Floor
mouth was not involved.Left extended
hemiglossectomy with modified neck dissection
with free
radial forearm flape was done
47 years old female suffering from right parotid
deep lobe tumour extending to
parapharyngeal space encasing external carotid
for 180 degree and pushing right IJV.true cut
biopsy shows pleomorphic adenoma.Right deep lobe
parotidectomy done.
58 years old male suffering from right buccal
mucosa carcinoma since 30 days.patient was
operated for right lateral margin tongue
carcinoma before 18 months.patient was radiated
at
that time.not patient has right buccal mucosa
carcinoma without any spread.Right distal
marginal mandibulectomy with wide excision of
right buccal mucosa growth excision with right
PM flape done
37 years old female suffering from left chest
wall mass since 2 months.mass is
painful.patient has past h/o left breast
carcinoma surgery in 2020.patient has triple
negative disease.8 cycles chemo given.pet ct
shows tumour on left chest wall only.wide
excision of left chest wall tumour with left LD
flape done
37 years old male suffering from right lateral
margin tongue carcinoma.AP diameter is 5 to 6
cm and growth was free from floor mouth.Level 1
neck nodes are necrotic .right modified neck
dissection with right hemiglossectomy with
reconstruction of tongue with free radial
forearm
flape done.
38 years old female suffering from advance left
breast carcinoma.Lumpectomy was done before
2months reported carcinoma breast.ER -PR
negative.Her 2 positive.multiple axillary
nodes.Left modified radical mastectomy with
upper abdominal rotation flape was done.
47 years old male suffering from left buccal
mucosa growth involving left lower gingivo
buccal sulcus with outer cheek skin.upper
gingivobuccal sulcus is 6mm away from
growth.left
modified neck dissection with left distal
mandibulectomy with left cheek skin and buccal
mucosa growth excised with bilobe pectoralis
flape done.
67 years old male suffering from post radiation
osteonecrosis of mandible .past history of
lt tongue carcinoma befor 2 years .for that left
commando followed by radiation was
done.past history of right lower Gb sulcus
carcinoma before 7 years.for that free fibular
graft done.today left hemimandibulectomy with
left PM flape done.
52 years old male suffering from left tongue
carcinoma invading floor mouth.left modified
neck dissection with with extended left
hemiglossectomy with left pectoralis major flape
done.
62 years old male suffering from subglottic
carcinoma .patient was radiated for base tongue
carcinoma in jan 24 with radiotherapy .pet ct
shows new lesion in subtopic region.patient
had severe subglottic tracheal stenosis.patient
was operated for Laryngectomy with
pharyngectomy with patch pharyngoplasty with
pectoralis muscle.
51 years old male suffering from left buccal
mucosa carcinoma not involving retro molar
trigone.Ct scan shows 2cm x 1.8cm x.8cm growth
without any significant lymphadenopathy .Left
modified neck dissection with wide excision of
left buccal mucosa growth primary closure
with buccal pad of fat.
40 years old male suffering from right parotid
swelling.MRI shows tumour was arising from
right deep lobe of parotid pushing the fascia
nerve medially with extension of tumour in
neck.the size of the tumour was 8cm x 7cm.
Right total parotidectomy with complete
preservation of fascia nerve was done.
60 years old male suffering from left palatal
carcinoma reaching to supra notch level and
eroding floor of maxilla.three cycles neo
adjuvant chemo given.post chemo pet ct shows
complete resolution of tumour.left upper distal
mandibulectomy with left lower partial
maxillectomy with ALT done.
67 years old female suffering from non healing
ulcer on nose since 3 months.patient is not
responding to any local medicines.biopsy of
ulcer proved it to basal cell carcinoma.wide
excision with mid line forehead flape was done.
30 years old male suffering from right lower
gingivobucxal carcinoma having extensive
metastatic lymphadenopathy .Patient was given
three cycles of Neo adjuvant chemotherapy .CT
scan shows complete thrombosis of right IJV with
extension to brachiocephalic vein .Right
modified neck dissection with right distal
mandibulectomy with right PM flape done.
27 years old female having swelling in right
submandibular area haveing stone in duct.Right
submandibular gland excision done.
47 years old female suffering from left breast
lump in upper and outer quadrant involving
outer skin.Sonography shows level 1 axillary
nodes.USg liver is normal.left modified radical
mastectomy with left LD flape done.
42 years old male suffering from advance left
buccal mucosa carcinoma.The growth was
involving left mandible ,maxilla and floor
mouth.left hemimandibulectomy with left lower
partial maxillectomy with wide excision of left
buccal mucosa growth with bilobe PM flape
done.
57 years old female suffering from left breast
lump since 2 months.FNAC shows it is ductal
carcinoma.left axillary sonography was
normal.patient is diabetic and having
hypothyroidism.Left skin sparing mastectomy with
reconstruction by Lattismus dorsi flape
done.
51 years old female suffering from left breast
lump since 2 1/2 months.Left breast
lumpectomy was done outside shows mucinious
carcinoma with ductal carcinoma of breast .usg
shows some enlarge nodes in axilla.left skin
sparing mastectomy with left axillary clearance
with left latissimus dorsi flape for chest wall
reconstruction done
71 yrs old female suffering from left breast
mass in upper and inner quadrant of breast.USG
axillary shows some enlarge nodes.true cut
biopsy proves it carcinoma .Left modified
radical
mastectomy with primary closure done.
51 yrs old male suffering from right buccal
mucosa carcinoma involving angle mouth.There
were multiple neck nodes at level l and ll.Right
modified neck dissection with wide excision
of right angle mouth with buccal mucosa with
reconstruction of defect
with nasolabial and local flape was done.
71 years old male suffering from right lateral
margin tongue growth .Anetrio posterior
diameter was 5 cm.The growth was not reaching to
floor mouth and not crossing the
midline.Right modified neck dissection with wide
excision of right lateral margin
tongue growth with primary closure done
49 years old female suffering from left breast
carcinoma having size of 3.2 cm x2.8cm x2.2cm
.the tumour was in upper inner and outer
quadrant nearer to nipple.Skin sparing left
modified mastectomy with left Lattisimus dorsi
flape was done
36 years old male suffering from left neck nodal
mass having size of 7cm x 7cm infiltrating
to left IJV and CCA. Pet CT shows mass in left
neck node without any primary.left modified
neck dissection with left PM flape to cover the
carotid vessels.
36 years old female suffering from right upper
GB sulcus carcinoma .CT scan shows bilateral
neck lymphadenopathy .Othe investigation are
normal .Right modified neck dissection with
left SOHND with right upper lower partial
maxillectomy with right nasolabial
flape done
36 years old female suffering from right upper
GB sulcus carcinoma .CT scan shows bilateral
neck lymphadenopathy .Othe investigation are
normal .Right modified neck dissection with
left SOHND with right upper lower partial
maxillectomy with right nasolabial
flape done
63 years old female suffering from left buccal
mucosa carcinoma involving upper and lower
gingivo buccal sulcus.The tumour was extending
to left retromolar trigone.Left modified neck
dissection with left distal mandibulectomy with
left upper alveolectomy
with left PM flape done.
63 years old female suffering from left buccal
mucosa carcinoma involving upper and lower
gingivo buccal sulcus.The tumour was extending
to left retromolar trigone.Left modified neck
dissection with left distal mandibulectomy with
left upper alveolectomy
with left PM flape done.
60 years old female suffering from Right breast
upper and outer quadrant mass.There were
multiple nodes in Axilla.Right modified
mastectomy with primary closure done.
42 years old male suffering from right buccal
mucosa carcinoma invading right cheek skin
with large submandibular nodal mass.patient is
on anti tuberculous treatment since 90
days.patient is having extensive bilateral
pulmonary loci’s.Right modified neck
dissection with right hemimandibulectomy with
wide excision of right cheek growth with
bilobe PM flape done
42 years old female suffering from left buccal
mucosa carcinoma involving lower GB sulcus
with erosion of mandible.pt has also left
lateral margin tongue lesion looks like verrucus
lesion.Left modified neck dissection with left
distal segmental mandibulectomy
with wide excision of left buccal mucosa growth
with wide excision of left lateral margin
tongue lesion with Reconstruction with PM flape
done.
60 years old male suffering from Right buccal
mucosa carcinoma involving outer cheek skin
with large sub mandibular cystic necrotic
mass.pt is diabetic and hypertensive.ct scan
shows
involvement of mandible and upper alveolus.Right
modified neck dissection
with right hemimandibulectomy with wide excision
of right cheek growth with bilobe
pectoralis flape done.
36 years old male suffering from right floor
mouth and lateral margin tongue carcinoma.CT
scan shows multiple neck nodes .Right modified
neck dissection with right lateral margin
tongue with right floor mouth growth excision
with primary closure done
47 years old male suffering from lower central
arch gingivitis buccal carcinoma.MRI shows
growth involving the outer cortex of mandible.CT
scan shows bilateral neck nodes.Right
modified neck dissection with left SOHND with
central arch marginal mandibulectomy
with bilateral nasolabial flape done.
47 years old female suffering from Right upper
GB sulcus and alveolus carcinoma eroding the
alveolar arch.CT scan shows level I II nodal
enlargement.Right modified neck dissection with
Right upper alveolectomy with right upper GB
mucosal excision with
right palatal flape with right nasolabial flape
done
42 years old male suffering from left upper
alveolus and left upper GB sulcus carcinoma.HPE
shows sarcomatoid carcinoma .MRI shows growth
involving inferior maxillary wall and medial
pterygoid muscle .left modified neck dissection
with left near total
maxillectomy with left PM flape done.
67 years old female suffering from left breast
advance growth.HPE shows Invasive ductal
carcinoma .left Axilla shows multiple metastatic
nodes adherent to left axillary vein.Left
modified radical mastectomy with primary closure
done.
70 years old male suffering from left post 1/3
tongue carcinoma invading muscle of floor
mouth.patient has left level 2 & 3 positive neck
nodes.left modified neck dissection with
left distal segmental mandibulectomy with wide
excision of posterior 1/3
tongue growth with floor mouth growth excision
with left Pectoralis major flape done.
42 years old male suffering from left upper
alveolus and GB sulcus carcinoma.HPE shows
sarcomatoid carcinoma.MRI shows growth involving
inferior maxillary wall and medial
pterygoid muscle.Left modified neck dissection
70 years old female suffering from left medial
parth of thigh skin cutaneous malignancy with
prepuertal cutaneous nodules.patient was
operated for left extended vulvectomy with left
inguinal node clearance.it was reported T3N1M0.
Radiation was planned
but unfortunately before start of radiation
patient has recurrence at local site.so wide
excision of all cutaneous malignant nodules with
coverage of raw area with advancement of
flape with STG done.
77 years old male suffering from left maxillary
tumour.The tumour was eroding ant and post
wall of maxilla.Patient was operated for left
lower GB sulcus carcinoma in 2021.Today left
total maxillectomy with forehead flape done
61 years old male suffering from right lateral
ant 2/3 tongue carcinoma involving floor
mouth.patient was operated in 2019 for right
buccal mucosa carcinoma with ALT flape.post op
RT was given.in 2021 left buccal mucosa
carcinoma T1 lesion wide excision
was done .Left SOHND done.This time right
segmental mandibulectomy with right extended
hemiglossectomy with right PM flape done.
46 years old female suffering from left upper
outer quadrant breast lump.lumpectomy was done
outside.it is reported invasive ductal carcinoma
.other investigations are
normal.considering tumour size left upper outer
extended quandrectomy with axillary
clearance with LD flape done.
80 years old female suffering from left breast
mass in upper and inner quadrant with blood
discharging sinus.mass was 6 cm * 6cm involving
skin.Usg shows no lymphadenopathy .x ray
chest is normal.left modified mastectomy with
primary closure done.
55 years old male suffering from right buccal
mucosa carcinoma extending in right retro
molar trigone.Right modified neck dissection
with right distal mandibulectomy with right
upper alveolectomy with right pectoralis major
flape done.
46 years old female suffering from right lower
gingivobuccal carcinoma without invasion of
mandible.ct scan shows lesion is 1.5cm* 2.0cm.
No neck lymphadenopathy .Right modified neck
dissection (preserving sternocledo mastoid and
spinal accessory nerve)
with right marginal mandibulectomy with right
nasolabial flape done.
40 years old female suffering from advance right
buccal mucosa carcinoma invading outer
cheek skin.Right mandible was eroded.right
radical neck dissection with right
hemimandibulectomy with right lower partial
maxillectomy with right cheek growth excision
with bilobe PM flape done.
70 years old female suffering from multi centric
right breast tumour.true cut biopsy shows
is is ductal carcinoma .patient is diabetic and
hypertensive.Right modified radical
mastectomy with rotation flape to cover the
chest wall done.
46 years old female suffering from left breast
lump since 15 months.left breast lumpectomy
was done before 1year.HPE shows left breast
phylloid tumour.after then patient had again
tumour in left breast at same site.FNAC shows
phylloid tumour.left breast
extended lumpectomy done.HPE shows malignant
phylloid.Again left breast modified mastectomy
with left KD flape was done
49 years old male suffering from right lateral
margin tongue growth .Growth is not crossing
midline.Ct scan shows growth on lateral margin
without invasion of floor mouth.right
modified neck dissection with right lateral
margin tongue growth excision
with primary closure done
68 years old male suffering from left neck
metastatic nodal mass involving left internal
jugular vein and left Internal carotid
artery.Primary was in left pyriform fossa.pet ct
shows metastatic nodal mass in neck with primary
in left PF.left modified
neck dissection with left IJV excision with left
PM flape done.
55 years old male suffering from left lateral
margin tongue growth .growth was touching to
midline and involving the floor mouth and left
GB sulcus.There was big submandibular nodal
mass which was involving the diagastric and
mylohoid muscle.left modified
neck dissection with left segmental
mandibulectomy with left extended
hemiglossectomy with
submandibular mass excision done.Defect was
closed with pectoralis major flape.
50 years old male suffering from right lower GB
sulcus carcinoma involving central
arch.patient was operated for left lower GB
sulcus carcinoma before 1year.at that time
segmental mandibulectomy with free fibular graft
was made.right lower FB sulcus growth
was involving fibular graft also.right extended
hemimandibulectomy with central arch of
mandible excision with fibular graft removal
with closure of defect was done with bilobe PM
flape done
50 years old female suffering from right breast
lump since 2 months.Lump was in outer and
upper quadrant of breast.right modified radical
mastectomy with breast reconstruction with
right LD flape done.
83 years old female suffering from left breast
lump since 3 months.lump was suddenly
increase in size.FNAC shows breast carcinoma
.usg of liver and axilla were normal .left
modified radical mastectomy was done.
53 years old male suffering from right buccal
mucosa advanced carcinoma .Growth was
involving outer cheek skin.right mandible was
eroded.Right modified neck dissection with
wide excision of right cheek growth with buccal
mucosa with right hemimandibulectomy
with bilobe pectoralis major flape done.
58 years old male suffering from left pyriform
fossa growth extending in to posterior
pharyngeal wall.patient had two attacks of CV
stroke.patient is known case of diabetes and
hypertension .Laryngectomy with pharyngectomy
with posterior pharyngeal growth
excision with patch pharyngoplasty with left
pectoralis flape done
57 years old male suffering from right neck node
mass which was very badly adherent with
right common carotid artery.Right IJV was
completely involved.right extensive nodal
clearance with right RND done.Right IJV was
removed.vessels were covered with
right pectoralis muscle.
39 years old female suffering from right breast
upper and outer quadrant mass.USG axilla
shows single necrotic node.Rest of the
investigations are normal.Right upper and outer
quadranctetomy with axillary clearance with
right LD flape done
39 years old male suffering from right buccal
mucosa carcinoma locally advanced and
involving outer cheek .ct scan shows erosion of
mandible .level 1 neck node is
necrotic.patient has complete trismus.right
modified neck dissection with right
hemimandibulectomy
with right lower partial maxillectomy with wide
excision of right cheek growth with bilobe
PM flape was done.
56 years old female suffering from left vulval
carcinoma extending to peri urethral
area.left inguinal nodes are necrotic.left
inguinal node Clearance with left extended
vulvectomy with rotation local flape done.
