A 49 year old male patient was referred to our centre following the exodontia of a third molar in the fourth quadrant and curettage of granulation tissue at the apical and distal level of the exodontia. The only personal history of interest was a smoking habit of 35 paq.-year and an alcoholic intake of 150g/d. The patient's family history included the death of his father from colon cancer. The symptoms on physical examination were pain and inflammation in the region of tooth 48 of several months' evolution, which did not improve after the tooth was exodonated, also presenting a bulge of bony consistency on palpation in the vestibular region of the fourth quadrant and with strictly normal mucosa on physical examination.

After analysis of the tissue extracted during the exodontia of tooth 48 by the Pathological Anatomy Service, it was reported as squamous cell carcinoma with well-differentiated cells. A clinical-radiological extension study was carried out at head and neck level, where a destructive neoformative lesion was found on computerised tomography affecting the body and mandibular branch and multiple right cervical adenopathies at all levels. At thoracic-abdominal level there was no evidence of distant neoplastic pathology and the general blood analysis showed no alteration in any of its parameters.
The case was discussed in the Functional Head and Neck Unit (UFCC) of our centre and was classified as a T2N2bM0 and radical surgical treatment was decided together with radiotherapy treatment using a three-field isocentric technique and concomitant chemotherapy.
A segmental mandibulectomy was performed from part 43 to the right subcondylar region, modified radical right cervical lymph node removal, temporal tracheostomy and reconstruction by means of microvascularised osteomyocutaneous fibula graft. The pathological anatomy catalogues the piece as Keratinising Squamous Carcinoma and involvement of 23 of the 35 lymph nodes removed with extracapsular invasion of the same, classifying it as pT2pN2b.

3.5 months after surgery, recurrence was observed after a new cervical CT scan due to the appearance of cervical tumours compatible with massive recurrence in the form of multiple bilateral adenopathies. The possibility of a new cycle of chemotherapy was discussed but ruled out due to the rapid massive recurrence, the lack of response to treatment and the low level of tolerance to chemotherapy on the part of the patient. The patient was referred for palliative care and died 6.5 months after surgery due to massive loco-regional recurrence.