We report a case of oral cancer that underwent surgery after graft replacement of the abdominal aorta for emergency abdominal aortic aneurysm and asymptomatic coronary artery bypass for 3-vessel coronary artery disease. A 66-year-old Japanese male had oral floor cancer, 3-vessel coronary artery disease and a huge abdominal aortic aneurysm, which were detected in preoperative examination. The patient underwent graft replacement of the abdominal aorta for the abdominal aortic aneurysm which was at high risk of emergent rupture. Two weeks later, the patient underwent coronary artery bypass graft to prevent perioperative myocardial infarction. A waiting period was necessary after the coronary artery bypass, so radiation therapy was administered to control tumor growth until surgery could be performed. Radiation therapy was completed with a dose of 30Gy and curative surgery was performed for oral cancer. The postoperative course was uneventful with no perioperative complications.
In this case, there were no abnormal findings, and the patient was asymptomatic despite having severe coronary artery disease. On the other hand, plain CT showed significant calcification of the coronary arteries. This case was associated with diabetes. Among diabetic patients, neuropathy may be asymptomatic in the presence of severe coronary artery disease. Therefore, it is considered important to detect coronary artery calcification by plain CT for preoperative screening in oral surgery including oral cancer.

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Here we report a case of immediate reconstruction for a segmental defect of the mandibular body using sagittal split sliding osteotomy and coronoid process grafting. The patient was a 62-year-old male with primary intraosseous squamous cell carcinoma of the mandibular body of the premolar region. After segmental resection of the mandibular body, the bone defect of 45mm in length was repaired with the external layer of the proximal mandibular segment of 45mm in length osteotomized sagittally to advance and bridge it into contact with the distal end of the remaining mandibular bone. To obtain bone thickness to enable future dental implant treatment, the resected coronoid process was grafted lingually to the bridging bone. To enable bone bridging, the mandibular arch was narrowed temporarily. After two years, functional reconstruction with a dental implant was performed. Prior to implant fixture placement, mandibular body step osteotomy was done to widen the mandibular arch of the reconstructed area. Four dental implants were placed in the mandibular reconstruction area of the left mandibular molar. Eleven months after the implant placement surgery, the final superstructure for the mandible and the removable partial dentures for the upper and lower jaws were attached. A screw-fixed implant bridge was fabricated on the reconstructed mandible using hard resin for crowns and was placed as the final prosthetic superstructure. There was no evidence of tumor recurrence over the five-year follow-up period and the patient was satisfied with the function of reconstructive occlusion restored by the implant prosthesis.

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