This is a case report of a 55 years old gentleman from Iraq, hypothyroid, chronic smoker with no other co morbidities initially presented with mass in left temporal region since 5 months, gradually progressive in nature. It was associated with severe pain in ear. Biopsy in Iraq s/o squamous cell carcinoma. Patient underwent surgery which included only excision of mass in Iraq in 2019. However after 2 years patient again noticed swelling in left temporal region. Biopsy was suggestive of squamous cell carcinoma. Patient received radiotherapy in february 2021.

However disease was persistent and patient was put on palliative chemotherapy. However he continued to struggle with his earache. Patient then presented to our institute. On examination – There was infiltrating growth in left pre auricular region involving outer skin, parotid gland extending to external auditory meatus, middle ear, lower pinna. Slide review of previous biopsy was done which was suggestive of Recurrent/metastatic squamous cellcarcinoma in intra-parotid lymph nodes with local deposit within skin. Contrast enhanced MRI Neck showed a large irregular (4*3.5cm) growth in left temporal and inferior parotid regions invading the root of left pinna, infiltrating left EAC and lateral pterygoid muscles, minimally erosive in left styloid process extending to left temporo-mandibular joint.

We decided to go ahead with surgery as that was the only option left for him. We did a radical parotidectomy with left pinnectomy with lateral temporal bone resection with left posterior segmental mandibulectomy with left neck dissection(1b-5) with left eye lateral tarsorrhaphy with spiral PMMC flap reconstruction.

• Post operative period was uneventful
• Histopath report s/o poorly diff squamous cell carcinoma 4*3 cm, depth of invasion 1.3 cm
• ITF one focus tumor seen 0.2 cm
• Bone : mandible free, temporal bone involved.
• Perineural invasion detected
• Skin involved
• Lymph nodes 0/21

Patient received oral Metronomic chemotherapy ivo hpe findings. It consists of low dose methotrexate weekly 50mg, with geftanib 250 mg OD and celecoxib 200mg BD daily. Patient received 4 such cycles.

Patient was extremely content and returned home happy and painfree.