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| CASE REPORT |
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| Year : 2022 | Volume
: 10
| Issue : 4 | Page : 91-93 |
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Pleomorphic adenoma of hard palate: A novel case report
Sankar V Vichattu, Arun George, Joy R Das, Atic Thomas, Linta S George
Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Kerala, India
| Date of Submission | 14-Sep-2022 |
| Date of Acceptance | 14-Oct-2022 |
| Date of Web Publication | 30-Dec-2022 |
Correspondence Address:
Dr. Linta S George
Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, Kerala
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/INJO.INJO_23_22
Pleomorphic adenoma (PA) is one of the most commonly seen benign tumors that affect salivary glands. Among the major salivary glands, it mostly affects the parotid, whereas in the hard palate it affects the minor salivary glands, which account for about 40–70% of all salivary tumors. This case report describes a case of an edentulous female who developed a mixed tumor in the minor salivary gland of the hard palate, which was successfully removed by surgical excision. Keywords: Minor salivary gland tumor, palate, pleomorphic adenoma
How to cite this article:
Vichattu SV, George A, Das JR, Thomas A, George LS. Pleomorphic adenoma of hard palate: A novel case report. Int J Oral Care Res 2022;10:91-3 |
How to cite this URL:
Vichattu SV, George A, Das JR, Thomas A, George LS. Pleomorphic adenoma of hard palate: A novel case report. Int J Oral Care Res [serial online] 2022 [cited 2023 Mar 24];10:91-3. Available from: https://www.ijocr.org/text.asp?2022/10/4/91/366315 |
| Introduction | |  |
According to Ronald H. Spiro, “In any patient who presents with a swelling in the area of major or minor salivary glands, or a submucosal mass within the oral cavity or the pharynx, no matter if the swelling has been persistent for years, the possibility of salivary tumor must be strongly considered.”[1]
Tumors of the minor salivary glands account for approximately 18% of all salivary gland tumors. The most common location of minor salivary gland tumors, either benign or malignant, is the palate. About 56% of the salivary gland tumors of the palate were benign; all these were pleomorphic adenoma (PA), also called mixed tumors. The other possible minor salivary gland sites involved are tongue, upper lip, buccal mucosa, retromolar trigone, and floor of mouth.[2],[3]
The name pleomorphic adenoma derives itself from the architectural pleomorphism observed through light microscopy.[2]
| Case Report | | |
A female, aged 72 years, had come to our Department of Oral and Maxillofacial Surgery, complaining of an enlarging palatal mass of several months duration which had been causing her dentures to fit poorly. History revealed that the swelling was painless and had gradually grown over months to its current size.
On general examination, all the vital signs were within normal range with no history of diabetes or hypertension. Dental history revealed her to be a denture wearer since the past 30 years.
The extra-oral examination showed no gross facial asymmetry, lymphadenopathy, nor any other apparent abnormality.
On intra-oral examination, a solitary ovoid-shaped swelling, with overlying normal appearing mucosa, measuring 3 cm × 2 cm was seen in the right postero-lateral aspect of the hard palate The mass extended anteriorly from 13 area irt palate till the area of 18, posteriorly. Medially, it originated at the midline irt hard palate till the distal portion 17 area laterally [Figure 1]. The overlying soft tissue looked normal and smooth, with no secondary alterations. On doing palpation, the mass appeared firm, unilocular, non-pulsatile, non-tender, and immovable having well-defined margins. The mucosa overlying was non-pinchable and stretched. | Figure 1: Pre-operative view of the lesion showing the left hard palate swelling
Click here to view |
Cone-beam computed tomography of maxilla was taken [Figure 2]A-C which revealed a well-defined homogeneous area with soft tissue density of dimension 18.80 × 16.01 mm present on the right hard palate extending in relation to the edentulous alveolar ridge of 16 with elevation of the floor of maxillary sinus. The lesion showed expansion in all directions with displacement of palatal cortical plate buccally and elevation of the floor of maxillary sinus. | Figure 2: (A) Sagittal section showing elevated floor of maxillary sinus. (B) Coronal section showing lesion at the level of floor of maxillary sinus. (C) Axial section showing lesion with displacement of palatal cortical plate buccally
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With all findings, case was planned under local anesthesia for surgical excision. A crevicular incision was done starting from the mesial alveolar crest of 13 till the distal crest of the area of 18 with No. 15 blade [Figure 3]. Once mucoperiosteal flap got reflected, the whole tumor mass was removed en-toto along with affected periosteum [Figure 4]. Hemostasis was achieved and wound closure done using 3-0 silk.
| Discussion | | |
PA usually presents as a progressive slow-growing swelling, which is asymptomatic and firm in consistency.[4] PA has both mesenchymal and epithelial origin, which is well separated from surroundings using fibrous capsule that is formed due to fibrosis of the nearby salivary parenchyma of the tumor and is called a false capsule. PA can be detected and treated earlier when compared with other tumors of the major salivary glands. If the mucosa overlying looks ulcerated, and if it is not caused by any trauma nor biopsy, malignancy needs to be considered.[5]
Spiro et al.[1] in their study noted that 20–40% of all salivary gland masses originate from the minor salivary glands, which afflict mostly people in their fourth to sixth decade of life, having a predilection for females.
Histopathologic report depicted an epithelial mass of complex architecture, having epithelial as well as myoepithelial components arranged in various patterns and embedded inside mucopolysaccharide stroma [Figure 5], which is consistent with PA.[5] | Figure 5: Histopathological image showing epithelial as well as myoepithelial components arranged in various patterns
Click here to view |
According to Suhail et al., surgical treatment via wide local excision with removal of periosteum as well as bone curettage is preferred mode of treatment. Reconstruction is required only if there is full thickness involvement of bone; otherwise, excellent prospects are observed if wound is left to granulate and heal on its own. Using as obturator or palatal flap is the most common method to reconstruct the morbidity. Recurrences are rare but might be observed if on long-term follow-up.[3]
No recurrence is noted after adequate surgical excision. Incomplete excision, seeding, cutting through the microscopic extracapsular projections thereby leaving some tumor behind, or rupture of the capsule and accidental seeding of tumor cells are the common causes for recurrence.[6]
| Conclusion | | |
PA of hard palate is mostly observed in adults. Confirmative diagnosis relies on histopathological results. CT is essential for confirming any bony erosion. Treatment by wide local excision is one of the commonest modalities.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, [but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Spiro RH Salivary neoplasms: Overview of a 35-year experience with 2,807 patients. Head Neck Surg 1986;8:177-84.  |
| 2. | Yousra Z, Saliha C Pleomorphic adenoma of hard palate: A case report. Pan Afr Med J 2021;38:146. |
| 3. | Patigaroo SA, Patigaroo FA, Ashraf J, Mehfooz N, Shakeel M, Khan NA, et al. Pleomorphic adenoma of hard palate: An experience. J Maxillofac Oral Surg 2014;13:36-41. |
| 4. | Gupta M, Gupta M Pleomorphic adenoma of the hard palate. BMJ Case Rep2013:1-2. doi: 10.1136/bcr-2013-008969. |
| 5. | Sharma Y, Maria A, Chhabria A Pleomorphic adenoma of the palate. Natl J Maxillofac Surg 2011;2:169-1. |
| 6. | Daniels JS, Ali I, Al Bakri IM, Sumangala B Pleomorphic adenoma of the palate in children and adolescents: A report of 2 cases and review of the literature. J Oral Maxillofac Surg 2007;65:541-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
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