squamous cell carcinoma ( scc ) of the buccal mucosa accounts for 23% to 37% of all intraoral cancers .
the highest incidence rate is observed in india , australia , brazil , france and south africa .
a male to female ratio is about 2:1 with the largest number of oral sccs developing in the fourth and fifth decades of life . because of the high recurrence rate and invasive behavior of this tumor , the prognosis is generally poor .
diaz et al 's showed that buccal squamous cell carcinoma ( scc ) is an aggressive cancer , with a tendency to recur locoregionally .
strome et al 's revealed that 80% of patients had evidence of recurrence by 5 years , while lin cs et al 's found that recurance rate was 34% by 5 years .
according to our search in pubmed medical data bases there was no similar reported case about the locoregional invasion and recuurence of buccal scc in iran . in march 2012,,a 32-year - old admitted in alzahra hospital medical center of isfahan , iran due to the swelling in the right cheek region that initiated from 6 months ago but rapidly grow during one month ago .
he had a history of right cheek surgery with cervical lymph node dissection 2 years ago that was histopathologicaly diagnosed as squamous cell carcinoma ( scc ) at stage ii ( t2n0m0 ) that justified no lymph node involvement in examination .
extra oral examination , revealed a swelling of 3  2 cm in the right cheek region with a firm consistency .
there were no palpable lymph node in the submandibular and cervical region and facial muscle paralysis was not existed .
head and neck ct with soft tissue windowingin 2010 , february showed a lesion in the right buccal region with dimensions of z 3.1  2.7 [ figure 1 ] .
that was surgically excised with all the involved surrounding tissues under the general anesthesia at that time .
ct image , axial view , soft tissue windowing , showe a soft tissue mass lesion with dimension of 3.1  2.7 in the right buccal mucosa .
( january 2010 ) in march 2012 , ct images showed a soft tissue mass lesion with dimension of 2.5  3.64 in the right cheek region with erosive involvement of right zygomatic bone(body and anterior portion of the arc ) , palatal bone , ramus of the mandible and involvement of infra temporal fossa and pterygoid muscles [ figure 2 ] .
ct image , axial view , soft tissue windowing , showe a soft tissue mass lesion with dimension of 2.5*3.64 in the right cheek region with erosive involvement of right zygomatic bone ( body and anterior portion of the arc ) , palatal bone , ramus of the mandible and involvement of infra temporal fossa and pterygoid muscles .
( march 2012 ) magnetic resonance imaging ( mri ) of face showed a lobulated heterogeneous non enhancing mass lesion that was 2.5 cm in diameter in the right buccal mucosa with extension to theright masticatory muscles , right soft palate , uvula and also involving the right palatine tonsil , which may represent a neoplastic recurrence .
there was a large non enhancing mass with diameters of 32  31 mm with low signal intensity in t1 images in the buccal mucosa representing the scar tissue in the previous surgical site .
there is a fatty degeneration of the medial and lateral pterygoid muscles and right sided tongue muscles which may represent muscle denervation due to the peripheral spread of the neoplastic process , involving the maxillary and mandibular branches of the trigeminal nerve [ figure 3 ] .
mri , a lobulated heterogeneous non enhancing mass lesion in the right buccal mucosa with extension to the right masticatory muscles , right soft palate , uvula and also involving the right palatine tonsil , which may represent a neoplastic recurrence , also note to the non enhancing mass with diameters of 32  31 mm in the buccal mucosa representing the scar tissue in the previous surgical site ( arrow ) .
( march 2012 ) pathological examination revealed a neoplastic proliferation of squamous epithelial cells with cellular nests .
the histopathological examination revealed a diagnosis of a well differentiated scc in the all affected tissues [ figure 4 ] .
histopathological views finally the complete excision of the mass in the right buccal mucosa and all affected tissues including right masticatory muscles , partial resection of the right maxillary and palatal bones and upper affected portion of mandibular ramus and zygomatic bone was done . due to the local invasion to the surrounding structures including adjascent bones and masticatory muscles and absence of lymph node involvement and distant metastasis , the stage of lesion was finally 4a ( t4an0m0 ) after surgery .
unfourthunetly , the patient did not refer to follow up after completion of the first chemotherapic duration . and
in march 2012,,a 32-year - old admitted in alzahra hospital medical center of isfahan , iran due to the swelling in the right cheek region that initiated from 6 months ago but rapidly grow during one month ago .
he had a history of right cheek surgery with cervical lymph node dissection 2 years ago that was histopathologicaly diagnosed as squamous cell carcinoma ( scc ) at stage ii ( t2n0m0 ) that justified no lymph node involvement in examination .
extra oral examination , revealed a swelling of 3  2 cm in the right cheek region with a firm consistency .
there were no palpable lymph node in the submandibular and cervical region and facial muscle paralysis was not existed .
head and neck ct with soft tissue windowingin 2010 , february showed a lesion in the right buccal region with dimensions of z 3.1  2.7 [ figure 1 ] .
that was surgically excised with all the involved surrounding tissues under the general anesthesia at that time .
ct image , axial view , soft tissue windowing , showe a soft tissue mass lesion with dimension of 3.1  2.7 in the right buccal mucosa .
( january 2010 ) in march 2012 , ct images showed a soft tissue mass lesion with dimension of 2.5  3.64 in the right cheek region with erosive involvement of right zygomatic bone(body and anterior portion of the arc ) , palatal bone , ramus of the mandible and involvement of infra temporal fossa and pterygoid muscles [ figure 2 ] .
ct image , axial view , soft tissue windowing , showe a soft tissue mass lesion with dimension of 2.5*3.64 in the right cheek region with erosive involvement of right zygomatic bone ( body and anterior portion of the arc ) , palatal bone , ramus of the mandible and involvement of infra temporal fossa and pterygoid muscles .
( march 2012 ) magnetic resonance imaging ( mri ) of face showed a lobulated heterogeneous non enhancing mass lesion that was 2.5 cm in diameter in the right buccal mucosa with extension to theright masticatory muscles , right soft palate , uvula and also involving the right palatine tonsil , which may represent a neoplastic recurrence .
there was a large non enhancing mass with diameters of 32  31 mm with low signal intensity in t1 images in the buccal mucosa representing the scar tissue in the previous surgical site .
there is a fatty degeneration of the medial and lateral pterygoid muscles and right sided tongue muscles which may represent muscle denervation due to the peripheral spread of the neoplastic process , involving the maxillary and mandibular branches of the trigeminal nerve [ figure 3 ] .
mri , a lobulated heterogeneous non enhancing mass lesion in the right buccal mucosa with extension to the right masticatory muscles , right soft palate , uvula and also involving the right palatine tonsil , which may represent a neoplastic recurrence , also note to the non enhancing mass with diameters of 32  31 mm in the buccal mucosa representing the scar tissue in the previous surgical site ( arrow ) .
( march 2012 ) pathological examination revealed a neoplastic proliferation of squamous epithelial cells with cellular nests .
these cells had a high nucleus to cytoplasm ratio with atypism and pleomorphism . also keratin
the histopathological examination revealed a diagnosis of a well differentiated scc in the all affected tissues [ figure 4 ] .
histopathological views finally the complete excision of the mass in the right buccal mucosa and all affected tissues including right masticatory muscles , partial resection of the right maxillary and palatal bones and upper affected portion of mandibular ramus and zygomatic bone was done . due to the local invasion to the surrounding structures including adjascent bones and masticatory muscles and absence of lymph node involvement and distant metastasis , the stage of lesion was finally 4a ( t4an0m0 ) after surgery .
unfourthunetly , the patient did not refer to follow up after completion of the first chemotherapic duration . and
buccal scc is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location , sex , age and habit .
buccal scc is an aggressive cancer with a high tendency to recur .. the incidence of buccal carcinoma is much higher in asia . in india ,
sharma et al revealed a male to female ratio of 2.2:1 with the largest number of sccs developing in the fourth and fifth decades of life .
most of the reported cases of scc have a history of alcoholism and/or nicotine addiction , while our case did nt have any history of nicotine and alcohol consumption . squamous cell carcinoma ( scc ) of the buccal mucosa
is a rare , but especially aggressive form of oral cavity cancer , associated with a high rate of recurrence .
in contrast other oral cancer , buccal scc has a worse stage that affects the survival and become poor prognosis .
scc of buccal mucosa has a failure rate even in patient with t1 , 2 n0 stage that can be due to inadequate therapy and aggressive nature .
there was a 100% overall incidence of local disease recurrence in patients with stage i and ii tumors treated with wide local excision alone and followed up for more than 2 years .
patients with t1- or t2-sized tumors had only a 78% and 66% 5-year survival , respectively .
postoperative radiotherapy was effective in decreasing locoregional failure in patients with close surgical margins , tumor thicker than 10 mm , high - grade tumors , positive node , and bone invasion .
intra - arterial chemotherapy followed by radiotherapy is to be considered in advanced cases . similar to the presented case .
the treatment of buccal carcinoma requires a multidisciplinary team approach because most of the patients are elderly and present with an advanced stage .
nearly one - third of patients have localized disease , that is , t1 or t2 ( stage i or stage ii ) lesions without detectable lymph node involvement or distant metastases , these lesions are treated with curative intent by either surgery or radiation therapy .
iin cs et al showed that scc of the buccal mucosa is an aggressive cancer with a high locoregional failure rate even in patients with t1 - 2n0 disease , so postoperative radiotherapy could led to a better locoregional control rate for patients and should be recommended for patients with t1 - 2n0 disease .
the 5-year actuarial survival rates were 80% after surgery and 82% after surgery and postoperative radiation therapy .
pop et al , showed a local recurrence rate of 45% , while schiza et al found the frequency as 56% in their research .
postoperative radiotherapy has resulted in a better locoregional control rate for patients and should also be considered for patients with the t1 - 2n0 disease for whom adjuvant therapy after radical surgery currently is not recommended by most guidelines . in the head and neck cancer , the most important prognostic factor is the presence or absence of neck metastasis .
deconde et al found that performance of neck dissection may decrease the risk of recurrence in primary scc of the buccal mucosa .
finally the search in a procedure that diminishes recurrence may open the window of knowledge in treatment and increase survival . because of low survival and high recurrence , more research needs to perform to understanding the pathogenesis of the disease that led to new therapeutic strategies .
 squamous cell carcinoma ( scc ) of the buccal mucosa accounts for 23% to 37% of all intraoral cancers , the prognosis is generally poor . 
 we reported a case of local invasion of buccal squamous cell carcinoma . 
 a 32-year - old man referred to the clinic with a chief complaint of swelling in the right cheek region that initiated from 6 months ago and rapidly grow from one month ago . 
 history of the patient revealed that he was undergoing a surgery for buccal squamous cell carcinoma ( scc ) lesion 2 years ago . computed tomography ( ct ) and magnetic resonance(mri ) images showed a heterogenous mass in the right maxillary , palate and mandibular regions that was histopathologically diagnosed as recurrence with locoregional invasion of scc . 
INTRODUCTION
Patient case presentation
DISCUSSION