From unresectable to resectable: a multidisciplinary Head & Neck cancer journey.
A medically fit man in his early 40s presented with T4b buccal squamous cell carcinoma, initially considered unresectable.
Following MDT discussion, he received 3 cycles of neoadjuvant immunotherapy, with significant tumour regression allowing definitive surgery.
He underwent extensive resection including buccal/cheek resection, marginal mandibulectomy and partial anterior maxillectomy, leaving a complex defect involving the cheek skin, buccal mucosa, maxilla and mandible.
Reconstruction was performed using a double-paddle anterolateral thigh (ALT) free flap, designed to simultaneously reconstruct the external cheek and internal oral lining while covering the exposed bony structures.
The patient recovered well, thank God, and left the hospital after a week, and will complete the rest of his assisted treatment.
A case that highlights the importance of integrating immunotherapy, advanced surgery, and microvascular surgery in the treatment of complex head and neck tumors
Awareness Message
Oral cancer can progress significantly without obvious symptoms in its early stages. Therefore, it is important to pay attention to any lump, ulcer, or unusual change in the mouth and seek medical attention early. Early diagnosis and specialist evaluation may provide better treatment options and help reduce the complexity of surgical interventions. This case also highlights the importance of a multidisciplinary approach, where neoadjuvant immunotherapy helped reduce the tumor size and improve its surgical resectability, followed by advanced surgery and complex reconstruction using free tissue transfer. The case demonstrates how advances in head and neck cancer treatment, combined with collaboration among specialized medical teams, can provide advanced treatment options even in complex cases. This case was shared for medical education and awareness purposes, with full respect for the patient's privacy and removal of all information that could reveal their identity.