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.
Question(s) For Expert Witness
- 1. How often do you see patients with squamous cell carcinoma of the tongue?
- 2. Given the patient's complicated past medical history, was a bone graft at a higher risk of failure?
- 3. What are the options for reconstruction in a patient like this one?
Expert Witness Response E-008352
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. Radiation, in particular, makes reconstruction more difficult. Other options for reconstruction depend on more case particulars, but in general, they include autogenous cortico-cancellous bone graft or vascularized bone graft.