Carcinoma buccal cavity: Late presentation and salvage, experience from a North Indian center

Carcinoma buccal cavity, the most common oral cavity cancer was seen in our set up in more than 50% cases. Forty patients of carcinoma buccal cavity were studied at JN Medical College, Aligarh Muslim University, and Aligarh over a period of last 5 years (2003-2008). Mean age at presentation 36.5 years (30-55) years. Male: Female, 27:13. Most common association was with smoking and chewing tobacco and pan over a mean long period of 15 years (8-22 years). Most common location was lateral wall of buccal cavity over cheek area related to their typical chewing habit of keeping the tobacco over that area over a prolonged period. Most of them, more than 90% (36 cases) presented late involving both mucosa and skin and in 25% cases also involving the alveolus and mandible. Wide excision and modified radical neck dissection with or without mandibulectomy (marginal, partial or hemimandibulectomy) done in all cases. Reconstruction was done by pedicled pectoralis major (PM) and deltopectoral (DP), the workhorse flaps for head and neck reconstruction for mucosal lining and skin cover respectively in 25 cases. Five cases needed only lining done by PM flap. Ten cases were salvaged by pedicled forehead flap for both lining and cover. All the cases healed properly with acceptable results and good functional recovery. Two cases reported recurrence treated with postoperative radiotherapy. Poor socioeconomic status, smoking and chewing habit, poor oral hygiene, malnutrition and moreover lack of awareness led to late presentation. However, an attempt was made for salvage at our center.