Maxillary and Cervical En Bloc Resection With Consideration of the Lymphatic Flow Pathway for Maxillary Gingival Carcinoma: A Case Report.

En bloc resection of the primary tumor along with the cervical lymphatic tissue is not commonly performed in patients with maxillary gingival carcinoma because of the physical distance between the primary lesion and cervical metastatic site. However, delayed metastases to lymph nodes outside the standard dissection range, such as the buccinator lymph nodes, may adversely affect the prognosis. We report the case of an 87-year-old woman with right maxillary gingival carcinoma with submandibular lymph-node metastasis in whom en bloc resection of the maxilla and cervical region was performed with inclusion of the buccal space because of concern for possible occult lymphatic spread. Postoperative pathological examination revealed three metastatic submandibular lymph nodes and negative surgical margins. No recurrence was observed for > 5 years after surgery. Buccinator lymph nodes are difficult to identify on preoperative imaging. Therefore, en bloc resection that includes the buccal space may be beneficial in high-risk cases.