Risky Bone Graft Causes Oral Cancer Patient To Develop Infection

Case Overview

This case involves a 66-year-old woman with a history of multiple surgeries for oral cancer over 5 years and 15 treatments of radiation therapy. She was diagnosed with squamous cell carcinoma of the tongue and floor of the mouth. She was given a bone graft from the anterolateral thigh flap which eventually failed. Following the graft failure, the patient developed an oral infection and sought a second opinion and followed up with a different ENT specialist. The subsequent ENT specialist opinion was that the bone graft never should have been done because it put the patient at a significant risk of failure and that it gave her no alternative or recourse for subsequent action. An expert in oral and maxillofacial surgery was sought to opine on the standard of care.

Questions to the Oral Surgery expert and their responses

How often do you see patients with squamous cell carcinoma of the tongue?

As the director of predoctoral oral and maxillofacial surgery program at my institution, I see patients with squamous cell carcinoma of the tongue at least 2 to 3 times monthly, often more.

Given the patient's complicated past medical history, was a bone graft at a higher risk of failure?

Radiation, in particular, makes reconstruction more difficult.

What are the options for reconstruction in a patient like this one?

Other options for reconstruction depend on more case particulars, but in general, they include autogenous cortico-cancellous bone graft or vascularized bone graft.

About the expert

This expert has over 30 years of experience in the field of dentistry and oral and maxillofacial surgery. He earned his BA from St. Michael?s College, his MBA from Union Graduate College, and his DDS from Columbia University. He then completed an internship in general dentistry at St. Clare's Hospital, a residency in oral and maxillofacial surgery at the Long Island Jewish Medical Center, and a fellowship in oral and maxillofacial surgery at the East Grinstead Hospital in Sussex, England. Today, this expert is board certified in oral and maxillofacial surgery and is a licensed dentist. He is a member of the American Dental Association, the American Association of Oral and Maxillofacial Surgeons, and Health Volunteers Overseas. He is very active in academia, having published and presented extensively on topics related to oral and maxillofacial surgery. This expert previously served as the chief of dentistry and oral surgery at St. Clare's Hospital and as an oral surgery consultant for the New York State Department of Health. He later held positions as an associate professor of oral and maxillofacial surgery and as the director of the oral and maxillofacial surgery predoctoral surgical program at the VCU School of Dentistry. He was also in private practice for nearly thirty years. Currently, he serves as a professor emeritus of oral and maxillofacial surgery at a medical school in Virginia.