ONCOLOGY

CRITICAL CARE

ANAESTHESIA

RADIOLOGY

DERMATOLOGY

<p>The patient underwent a previous surgery for carcinoma of the buccal mucosa on the left side, involving a wide local excision with segmental mandibulectomy and PMMC flap reconstruction, performed two years ago by an oncologic surgeon. Due to recurrence, revision surgery was planned. Tumor resection was performed, and a free fibula flap was planned for mandibular reconstruction. Simultaneously, fibula flap harvesting and neck dissection were initiated. However, a rare anatomical variation of the carotid artery was encountered, with a high bifurcation of the carotid artery above the angle of the mandible at or above the C2 vertebral level. No superior thyroid or facial vessels were encountered. The first vessel located was the lingual artery, but no flow was present. Similar findings were observed on the opposite side of the neck. Consequently, the surgical plan was immediately revised, and a pedicled LD flap was used to cover the mucosal and cutaneous defects over the reconstruction plate. The patient is doing well on postoperative day 4, and the flap is healthy.The patient underwent a previous surgery for carcinoma of the buccal mucosa on the left side, involving a wide local excision with segmental mandibulectomy and PMMC flap reconstruction, performed two years ago by an oncologic surgeon. Due to recurrence, revision surgery was planned. Tumor resection was performed, and a free fibula flap was planned for mandibular reconstruction. Simultaneously, fibula flap harvesting and neck dissection were initiated. However, a rare anatomical variation of the carotid artery was encountered, with a high bifurcation of the carotid artery above the angle of the mandible at or above the C2 vertebral level. No superior thyroid or facial vessels were encountered. The first vessel located was the lingual artery, but no flow was present. Similar findings were observed on the opposite side of the neck. Consequently, the surgical plan was immediately revised, and a pedicled LD flap was used to cover the mucosal and cutaneous defects over the reconstruction plate. The patient is doing well on postoperative day 4, and the flap is healthy.</p>