A case of necrosis of the mandible occurring after superselective intra-arterial chemotherapy for squamous cell carcinoma of the upper gingiva

Superselective intra-arterial infusion therapy using Seldinger's technique is frequently performed atmany institutions to improve treatment outcomes in patients with advanced head and neck cancer. However, complicationsrelated to control nerve dysfunction and local toxicity have been reported in association with the use ofthe one-shot infusion procedure. We report a case of bone necrosis of the mandible after superselective intra arterialinfusion therapy in a 74-year-old woman with carcinoma of the upper gingiva. She received conventional concomitantextrabeam radiotherapy (36 Gy) and superselective intra-arterial infusion therapy with CBDCA (300mg) via the maxillary artery.After superselective intra-arterial infusion chemotherapy, necrosis of the medial pterygoid muscle, extending tothe area around the mandible, was recognized. Thereafter, sequestration and a fracture of the mandible developedtwo times within 1 year after this treatment. Sequestrotomy and intramaxillary fixation for the fracture were performed.Thereafter, both new bone formation and bone remodeling were confirmed.We suspect that this side effect was caused by leakage of CBDCA to the surrounding tissue, moving thecatheter to another artery, or spasm of the maxillary artery.