Turning Failure into Success: Prosthetic Rehabilitation After Surgical Setback in Gingival Squamous Cell Carcinoma

Abstract

Oral squamous cell carcinoma (OSCC) is a common malignancy that can develop from precancerous conditions such as oral lichen planus (OLP). This case report describes the clinical management and complication reporting of a patient with OLP who developed an exophytic lesion on the anterior maxillary gingiva, diagnosed as well-differentiated OSCC (cT1N0M0). Surgical treatment included anterior maxillectomy and reconstruction using an iliac crest bone graft housed in a customized CAD-CAM titanium mesh, covered by a facial artery musculomucosal (FAMM) flap. Postoperatively, the patient experienced significant surgical complications, including FAMM flap dehiscence and subsequent necrosis of the underlying bone graft, leading to total graft failure. Management of these adverse events required aggressive wound care, hyperbaric oxygen therapy, and complete removal of the exposed titanium mesh under local anesthesia, classified as a Grade IIIad complication according to the Clavien–Dindo system. To address the functional and aesthetic deficits resulting from the surgical failure, the patient was successfully rehabilitated using a removable partial prosthesis. This report highlights the novel clinical lesson that while CAD-CAM mesh reconstruction is innovative, high soft-tissue tension in dynamic maxillary regions represents a critical failure risk; it demonstrates that conventional removable prosthetics served as a successful, low-morbidity rescue strategy in this patient when complex surgical reconstructions failed.