Microscopic Coblator Assisted Excision of Adenocystic Carcinoma of Soft Palate: A Novel Modality

Adenoid cystic carcinoma (ACC) is a rare malignancy arising from the exocrine glands. It most commonly involves the minor salivary glands. In the oral cavity, palate is the commonest site. For palatal ACC, surgical resection is the primary treatment of choice. However the tumour location makes complete resection demanding, due to its associated complications of velopharyngeal insufficiency, oronasal fistula, foreign body sensation and pain. Various techniques like coblation, CO₂ laser and robotic surgery are available for the trans-oral resection of oral and oropharyngeal tumours. Recently, the use of coblator in the treatment of oropharyngeal malignancy has generated a considerable interest. Coblation is a suitable tool for resection of oral and oropharyngeal tumours with a favourable intraoperative performance and less post-operative morbidity. It allows working around the corners, is faster, cheaper and has the ability to achieve better haemostasis in comparison to other surgical modalities. Herein, we present an elderly lady with a palatal tumour which was benign on clinical examination and encapsulated with maintained fat planes on radiological evaluation. She underwent coblator assisted resection under microscopic vision which allowed quick excision with adequate margins under magnified vision. There were minimal post-operative complications. Histopathology documented the lesion as ACC with free surgical margins. It should be kept in mind that palatal mass even if clinically and radiologically benign may harbour malignancy. Use of coblator under microscopic vision allows delineation between tumour and different layers of palatal muscles which helps in more accurate and individualised resection and reduced postoperative morbidity.