Large ulcerative lesion (7 × 6 cm) in right buccal mucosa

• Extending from right lower gingivobuccal sulcus to occlusal plane
• Anterior extension involving lip commissure
• Crossing midline to left lower gingivobuccal sulcus (approx. tooth 33)
• Right cheek induration present

• Impact on Lymph Node
  • Enlarged Level Ib lymph node (indurated to skin) n
  • Enlargement of Level II and III lymph nodes

• Neck Dissection
  • Neck incision given with extension from primary lesion
  • Subplatysmal flap raised
  • External Jugular Vein (EJV), Facial Vein, and Facial Artery ligated Subplatysmal flap raised
  • Sternocleidomastoid muscle (SCM) sacrificed
  • Modified Neck Dissection (MND) performed
• Internal Jugular Vein (IJV) preserved

• Buccal mucosa defect: 8 × 8 cm
• Skin defect: 6 × 6 cm

Reconstruction Method

• Successfully reconstructed using Single Paddled PMMC Flap (Pectoralis Major Myocutaneous Flap)
• Intraoral raw area adequately covered

The surgery was successfully completed, achieving:

• Complete tumor removal
• Adequate neck clearance
• Effective functional and structural reconstruction

• Advanced Stage IV oral cancer managed successfully
• Complex wide excision + neck dissection + reconstruction
• Demonstrates expertise in OMFS oncology surgery