Surgery for oral cancer that has extended to the midface region requires an approach to the site where blood vessels and nerves run intricately, and bleeding makes the operation more difficult. In addition, occlusal reconstruction and prosthesis fitting after extensive resection of a maxillary tumor are very difficult because an anchor for fixing the prosthetic device may not be possible. We report a case of giant carcinoma ex pleomorphic adenoma of the midface treated by a multidisciplinary approach involving airway management, nutrition management by gastrostomy, embolization, surgery and occlusal reconstruction.
The patient was a 56-year-old man who presented with an extensive mass in the hard palate. He reported having been diagnosed with pleomorphic adenoma six years ago at another hospital, but stopped going to the hospital. We performed a biopsy of the mass in the hard palate at our institution, which was diagnosed as carcinoma ex pleomorphic adenoma. We discussed with relevant departments （e.g., otorhinolaryngology, radiology, ophthalmology, gastroenterology and anesthesiology） and planned endovascular embolization, tracheostomy and gastrostomy before surgery. Transcatheter maxillary artery embolization was effective for reducing blood loss for subtotal maxillectomy. Regarding postoperative occlusal reconstruction, although there were extensive maxillary defects, sharing of the preoperative treatment plan enabled early resumption of oral intake with an immediate surgical obturator. Two years have passed since the operation and there has been no recurrence.
View full abstract