A Case of Massive Recurrent Pleomorphic Adenoma of the Palate

Special Article - Oral and Maxillofacial Surgery

J Dent & Oral Disord. 2016; 2(8): 1041.

A Case of Massive Recurrent Pleomorphic Adenoma of the Palate

Faisal M¹ and Mishra S²*

¹Department of Dentistry, Jamia Millia Islamia, New Delhi, India

²ESIC Dental College, New Delhi, India

*Corresponding author: Sonal Mishra, ESIC dental college, New Delhi, India

Received: September 26, 2016; Accepted: October 31, 2016; Published: November 02, 2016

Abstract

Pleomorphic adenomas are the most common benign tumors arising from the cells of salivary gland tissue characterized by the presence of both epithelial and mesenchymal elements. About 10 percent of the pleomorphic adenomas occur in the palatal minor salivary glands. The present case is that of a 73 year female patient that reported with histopathological diagnosed case of a massive recurrent pleomorphic adenoma of the palate. The patient was reportedly operated elsewhere 20 years ago and had developed a diffuse enlargement of bilateral maxillae since 5 years. Computed tomography scan showed extensive bony destruction with tumor extension diffusely into bilateral maxilla, nasal and palatine bones inferiorly. Superiorly approximating the floor of the orbit and extending distally into the sphenoid bones and the cranial base. Case assessment conclusion was that of an inoperable tumor with areas of cranial extension. The patient was treated symptomatically and was kept on basic life support.

Background

Pleomorphic adenomas are the most common benign tumors arising from the cells of salivary gland tissue characterized by the presence of both epithelial and mesenchymal elements. Pleomorphic adenomas may occur at any age but occur more commonly in 3rd to 6th decade of life and are slightly more frequent in women (male-tofemale ratio 1:1.39) [1]. 60 to 85 percent of pleomorphic adenomas occur in the parotid. The minor salivary glands of the palate account for only 10 percent of the pleomorphic adenomas. The site of predilection is the mucosa over the posterior hard palate and anterior soft palate. Most frequent presentation initially is a firm painless mass with intact overlying mucosa. Ulceration may be present secondary to trauma or previous biopsy. Ulceration not secondary to the above mentioned causes may be malignant. The tendency to recur and the accompanying risk of malignant transformation make the clinical diagnosis and treatment of pleomorphic adenomas important. The rate of malignant transformation reported in literature is 1.5% to 23%.

Case Presentation

A 73 year old female patient reported to the maxillofacial department with complaint of a large growth in the upper jaw bone. Clinical examination revealed severe facial deformity with expansion of bilateral maxillae and palatine bones, deformed nasal bones, left malar prominence and no regional lymphadenopathy. Few mobile teeth (two premolars on the right side and molars on the left side) were present in the enlarged maxilla. Anterior palate had areas of ulceration left over by extraction or by trauma from mandibular teeth. Indentations of mandibular teeth were present bilaterally (Figure 1-3). The patient was on assisted respiration by a nasotracheal intubation. She was poorly nourished, her weight was 33 kg, and she could not walk by herself. The patient reported of twice being operated for a pleomorphic adenoma of the palate. The first surgery was performed 20 years ago. The second surgery of a pleomorphic adenoma. Since then the medical condition of the patient deteriorated and the recurrent enlarged mass at present state was considered to be inoperable after a thorough examination of the tumor extension using a computed tomography scan (Figure 4-8).