Pectoralis major myocutaneous - A work horse flap in intraoral reconstruction: A case report

Oral squamous cell carcinoma (SCC) remains a major public health concern in India, particularly among individuals with tobacco and areca nut habits. Advanced-stage disease involving the mandible presents considerable surgical and reconstructive challenges, especially in resource-limited healthcare settings. This report describes the clinical management of a 56-year-old male patient diagnosed with moderately differentiated squamous cell carcinoma of the left mandibular alveolus. Following clinical and radiographic evaluation, the patient underwent hemimandibulectomy with modified radical neck dissection (MRND II). Reconstruction was achieved using a Pectoralis Major Myocutaneous (PMMC) flap. Histopathological examination confirmed bone involvement and a single metastatic lymph node with perinodal extension. Surgical margins were adequate, and there was no evidence of perineural or lymphovascular invasion. Based on these findings, the case was staged as pT4N1M0, and the patient was referred for adjuvant chemoradiotherapy. The PMMC flap provided effective coverage of the defect, demonstrating favorable postoperative recovery, acceptable aesthetics, and preserved function. This case underscores the continued relevance of the PMMC flap as a robust, versatile, and cost-effective reconstructive option for large mandibular defects in oral cancer patients. While microvascular free flaps are preferred in advanced centers, PMMC flaps remain indispensable in high-volume or resource-constrained settings. The report highlights the importance of comprehensive pathological assessment in guiding postoperative treatment and prognosis in oral SCC cases.