We experienced a case of oral squamous cell carcinoma of the mandible with scattered distant metastases. After neoadjuvant chemoradiotherapy, the patient underwent segmental resection of the right mandible and right radical neck dissection. Surgical specimens confirmed remarkable nodal metastases. Unfortunately, the patient experienced a rapid fatal outcome, and numerous distant metastases were detected on autopsy. Moreover, postoperative 18F-fluorodeoxyglucose- positron emission tomography/computed tomography detected systemic distant metastases in this case. In our opinion, the use of preoperative FDG-PET/CT should be considered for patients with suspected poor prognoses.