[Axillary metastases of oropharyngeal carcinoma after pectoralis major flap]

Reconstruction of defects after resection of advanced head and neck tumours with the pedicled myocutaneous pectoralis-major-flap is a well established method of regional plastic surgery. A 66 year old female patient with an oropharyngeal squamous cell carcinoma was treated by surgery and radiotherapy in curative intention. A few months later a local recurrence could be resected by a lateral pharyngotomy while the defect was reconstructed with a myocutaneous pectoralis-major-flap. Together with another local relapse at the pectoralis-major-flap in the oropharynx a painless tough swelling developed in the ipsilateral axilla which revealed histologically as a lymph node metastasis of a squamous cell carcinoma. Because no second malignoma as a source for this metastasis could be found, a lymphogenous spread of the oropharyngeal carcinoma along the pedicle of the flap could be the most probable explanation for this rare event. As a conclusion of this observation all patients with pedicled reconstructions after resection of head and neck cancer should not only be examined in the tributary lymph node levels of the neck but also in the axilla during oncological follow up.