<p>Pleomorphic adenomas (PA) commonly involve major salivary glands in 84–86% cases. Minor salivary glands are rarely affected and account for 10–12% cases. They commonly manifest in the hard palate, lips, oral cavity, nasal cavity, nasopharynx and paranasal sinuses. Majority of cases of Pleomorphic adenoma of palate present with intact hard palate or minor erosion. Extensive erosion of hard palate with mass invading maxillary sinus is extremely rare. We present a rare scenario of a giant PA arising from hard palate which caused extensive bone erosion and extension to right side maxillary sinus, premaxillary region and laterally involved the upper alveolar arch with severe dental malocclusion. The patient presented with an intra-oral mass for the last ten years. The progressive extension of the mass caused facial swelling, dental malocclusion, dysphagia and muffled voice over the last two years. Clinical examination revealed a bulge in the naso-facial groove, an intraoral multilobulated palatal mass and ballooned out upper alveolar arch with increased interdental spacing of premolars and molars. After imaging and cytological diagnosis of PA, the patient was planned for right sided subtotal maxillectomy and obturator was placed to close the palatal defect. In rare scenarios, though benign in nature, the chronicity of PA causes extensive bone erosion leading to involvement of multiple anatomical subsites. Open approach surgery aids in complete resection of bulky palatal mass with loco-regional spread. Complete surgical excision requires extensive resection making rehabilitation a challenge. Pre-operative palatal impressions for an obturator, and subsequent customisation for better fit at regular intervals, is essential to promote early palatal healing and ensure the patient’s efficient and swift return to normal life.</p>

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Giant Pleomorphic Adenoma of the Hard Palate: Surgical Management and Prosthetic Rehabilitation

  • Sharmistha Chakravarty,
  • Unnati Dhabarde,
  • Prajwal Dange

摘要

Pleomorphic adenomas (PA) commonly involve major salivary glands in 84–86% cases. Minor salivary glands are rarely affected and account for 10–12% cases. They commonly manifest in the hard palate, lips, oral cavity, nasal cavity, nasopharynx and paranasal sinuses. Majority of cases of Pleomorphic adenoma of palate present with intact hard palate or minor erosion. Extensive erosion of hard palate with mass invading maxillary sinus is extremely rare. We present a rare scenario of a giant PA arising from hard palate which caused extensive bone erosion and extension to right side maxillary sinus, premaxillary region and laterally involved the upper alveolar arch with severe dental malocclusion. The patient presented with an intra-oral mass for the last ten years. The progressive extension of the mass caused facial swelling, dental malocclusion, dysphagia and muffled voice over the last two years. Clinical examination revealed a bulge in the naso-facial groove, an intraoral multilobulated palatal mass and ballooned out upper alveolar arch with increased interdental spacing of premolars and molars. After imaging and cytological diagnosis of PA, the patient was planned for right sided subtotal maxillectomy and obturator was placed to close the palatal defect. In rare scenarios, though benign in nature, the chronicity of PA causes extensive bone erosion leading to involvement of multiple anatomical subsites. Open approach surgery aids in complete resection of bulky palatal mass with loco-regional spread. Complete surgical excision requires extensive resection making rehabilitation a challenge. Pre-operative palatal impressions for an obturator, and subsequent customisation for better fit at regular intervals, is essential to promote early palatal healing and ensure the patient’s efficient and swift return to normal life.