Reconstruction of head and neck defects following oncological ablative surgery represents a considerable challenge for reconstructive surgeons. Common reconstruction options are the fibula, iliac crest, tip scapular and lateral scapula border free flap. The vascularized iliac crest free flap was first described by Taylor et al. in 1979 and it has been widely used for the reconstruction of composite head and neck defects. This flap guarantees excellent functional and aesthetic outcomes in the reconstruction of posterior segmental mandible defects. For the reconstruction of maxillary defects, it is important to note that the iliac crest bone shape usually allows for an adequate reconstruction without the need to conduct any osteotomies, and this substantially facilitates the flap inset. Thus, the iliac crest free flap offers a valuable reconstructive alternative that should be part of the armamentarium of all head and neck reconstructive surgeons. When this option is well indicated, the success rate, as well as functional and aesthetic outcomes, are comparable to other flaps used for reconstructing the maxillofacial area. The main aim of the present report is to analyze the importance of the DCIA flap for the reconstruction of complex defects of the maxillofacial region and to present possible applications, suggestions, and pitfalls associated with this technique.

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Tongue squamous cell carcinoma represents the most frequent and aggressive cancer of the oral cavity. It usually metastasizes via the lymphatic system at cervical level and distant metastases are uncommon. In case of metastasis outside the neck, the lung is the organ most frequently affected (1). In contrast, vertebral metastases are extremely rare. Approximatively, 7 cases of squamous cell carcinoma of tongue with spinal metastases have been described (2). The most common symptom related with vertebral metastases is the pain described as progressive and unremitting. Moreover, it is worse at night and usually improves with activity and anti-inflammatory medication (3). Motor and sensory dysfunctions are also common with the progressive spinal infiltration. X-ray, CT scan, PET and MRI are useful to confirm the lesion in case of suspicious. The treatment aims to reduce neurological disability and pain. According with literature, radiotherapy, palliative CT, decompressive surgery and steroids may be useful to manage this complication (4).We report three cases of vertebral metastases in patients affected by squamous cell carcinoma of the oral tongue. Two of these patients were males of 36 and 43 years old respectively (Patient 1 and 2), and the third was a female of 79 years old (Patient 3). All patients presented a positive biopsy for squamous cell carcinoma of the tongue before surgery and all of them underwent tumorectomy of the primary tumor and neck dissection. Interestingly, only one of these patients (patient 2) presented the common risk factors for squamous cell carcinoma of the oral cavity (alcohol and tobacco). According with the postoperative pathological findings the patients were staged as T2N1M0 (DOI 0.9 cm) (patient 1), T3N2aM0 (DOI 1.3 cm) (patient 2) and T1N2aM0 (DOI 0.4 cm) (patient 3) with free surgical margins. The clinical stage of the primary tumor was established following the recommendations of the International Union Against Cancer 8 th edition (UICC) (5).

Squamous cell carcinoma of the upper jaw is considered the least aggressive squamous cell carcinoma of the mouth and its tendency to metastasize is lower in comparison with other locations of the oral cavity. It usually metastasizes via the lymphatic system at cervical level and distant metastases are extremely uncommon. In this sense, only approximatively 50 cases of distant metastases have been described.We report a case of oral squamous cell carcinoma soft tissue metastasis affecting the paravertebral and vertebral region in a 60-year-old patient with a squamous cell carcinoma of the upper jaw. Following careful analysis of the case by the tumor board, the patient was referred to the orthopedic department for evaluation, and ultimately underwent ablative surgery to remove the single soft tissue metastasis. Unfortunately, due to the aggressiveness of the disease patient died 2 months after the surgical removal of the soft tissue metastasis.The main aim of this brief report is to describe this extremely rare location of distant metastases caused by a maxillary squamous cell carcinoma. Although squamous cell carcinoma of the upper jaw usually shows a better prognosis compared with other locations of the oral cavity, it might be particularly aggressive in certain patients.