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.
