Abstract
This report concerns a 55-year-old male with intracranial invasion and recurrence of lower gingival squamous cell carcinoma along the lingual nerve after initial treatment.
At hospital admission, he had stabbing left facial pain and dysesthesia of the left lower lip and chin. After preoperative radiotherapy, the patient underwent left hemimandibulectomy and radical neck dissection, right submandibular neck dissection, and then immediately received reconstructive surgery by using PMMC flap. Three months later, MRI revealed an enhanced mass in the base of the skull that was suspected to be the residual tumor progressing intracranially along the trigeminal nerve. The patient died 4 months later due to rapid growth of the residual tumor into the left middle cranial fossa. We confirmed by later histological examination that the carcinoma cells had invaded into the lingual nerve at the surgical margin of the efferent side, and residual cells had progressed to the skull base along the nerve via the foramen ovale. In a case like this, with paresthesia in the mental region and bone invasion detected at initial treatment, preoperative or postoperative radiotherapy of the area containing the skull base as well as extensive surgical excision of the primary lesion would seem to be an important preventive measure.
