2018 Volume 64 Issue 12 Pages 720-725
We report a case of lower gingival carcinoma with severe myocardial ischemia that developed during surgery. An 82-year-old man was referred to our hospital because of pain after tooth extraction. The patient had a history of coronary artery bypass graft surgery for angina pectoris 10 years previously and had stable ischemic heart disease. The preoperative laboratory data and the physiological and imaging findings were unremarkable. We planned tumor resection, including mandibular segmental resection and neck dissection, followed by reconstruction with a fibula flap. However, severe myocardial ischemia developed after tumor resection and neck dissection. Intra-aortic balloon pumping was applied to decrease cardiac load and maintain the circulation. Cardiac function recovered, and reconstruction was done using a pectoralis major musculocutaneous flap with plate fixation to minimize surgical invasiveness and decrease the surgical duration. This revised procedure was completed uneventfully, and the patient recovered without further myocardial ischemia or any other sequelae. The patient is currently doing well with no local tumor recurrence or angina pectoris.
