A 52-year-old female patient presented to our hospital with complaint of painful swelling in the left side of the face for past 6 months. Patient’s history reveals the swelling was initially small and attained the present size of 8 x 7 cm, associated with a throbbing type of pain. The swelling was hard in consistency, fixed, warm and tender with ulceration with bleeding spots on the surface, with no other secondary changes. The mouth opening was within acceptable limits with no facial nerve involvement. On general examination, the patient was poorly built and nourished with no recent weight loss. Lymph node examination revealed multiple regional lymph node involvement. Contrast enhanced CT scan revealed large moderately enhancing soft tissue density lesion arising from left parotid gland with regional lymph node involvement. Pre-operative aspirated cytology shows evidence of ductal carcinoma of left parotid gland. Treatment co0mprised of wide local excision (left segmental mandibulectomy + total parotidectomy) with compromising facial nerve, selective neck dissection (I-III), and reconstruction made with SSG (split skin graft) harvested from right thigh region. The excised specimen and lymph nodes were sent for histopathological evaluation which reveals that sections studied from the excised mass show a malignant neoplasm arranged in sheets nests and comedo pattern with central necrosis. The circumferential margins and sections from segmental mandibulectomy are free of tumor, involvement of skin, perineural invasion and vascular invasion of tumor is noted. Sections from the lymph node specimen shows secondary carcinomatous deposits. Patient had been sent for adjuvant radiotherapy post operatively.
