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DENTAL SCIENCE - CASE REPORT
Year : 2012  |  Volume : 4  |  Issue : 6  |  Page : 435-436  

Pleomorphic adenoma in an adolescent


1 Department of OMFS, JKKN Dental College and Hospital, Komarapalayam, Namakkal (Dt), Tamil Nadu, India
2 Department of Conservative Dentistry and Endodontics, Vivekanandha Dental College for Women, Tiruchengode, Namakkal (Dt), Tamil Nadu, India

Date of Submission01-Dec-2011
Date of Decision02-Jan-2012
Date of Acceptance26-Jan-2012
Date of Web Publication28-Aug-2012

Correspondence Address:
Vinod Thangaswamy
Department of OMFS, JKKN Dental College and Hospital, Komarapalayam, Namakkal (Dt), Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.100325

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   Abstract 

Pleomorphic adenoma generally occurs in the 4 th and 5 th decade of life. The adenoma is an uncommon presentation and is exceedingly rare in children and young adolescents. This case report deals with the diagnosis and surgical management of pleomorphic adenoma in the soft palate region in a young adolescent patient.

Keywords: Adolescents, bipedicle flap, palate, pleomorphic adenoma


How to cite this article:
Thangaswamy V, Sivakumar A, Sivakumar A, Sivaraj, Pugazhendi SK, Thambiah L. Pleomorphic adenoma in an adolescent. J Pharm Bioall Sci 2012;4, Suppl S2:435-6

How to cite this URL:
Thangaswamy V, Sivakumar A, Sivakumar A, Sivaraj, Pugazhendi SK, Thambiah L. Pleomorphic adenoma in an adolescent. J Pharm Bioall Sci [serial online] 2012 [cited 2020 Oct 22];4, Suppl S2:435-6. Available from: https://www.jpbsonline.org/text.asp?2012/4/6/435/100325

Salivary Gland neoplasms are rare in the pediatric population. Benign tumors make up 80% of salivary masses. Of these, pleomorphic adenomas, also known as mixed tumors (or benign mixed tumors) are the most common solid parotid tumors in children. While pleomorphic adenomas are benign,they have a predilection for recurrence. Additionally, they have the risk of malignant degeneration over time. These properties of pleomorphic adenoma necessitate their accurate diagnosis and appropriate management in children. The purpose of this case report is to present our experience with one pleomorphic adenoma in an adolescent and we hope to contribute to existing guidelines already present for the evaluation and management of these benign lesions throught his clinical experience. [1]


   Case Report Top


A 19-year-old male patient reported with a swelling in the posterior portion of his palate, which was present for the past 3 months. On examination, the swelling was 2 × 2 cm in dimension, extending anteriorly from the posterior portion of the hard palate, laterally 6 mm away from the left alveolar margin, medially 2 cm from the right alveolar margin, and posteriorly 1 cm anterior to the uvula [Figure 1]. The swelling was firm in consistency, nontender, and had no fixity to the overlying palatal mucosa or the underlying bone. The occlusal radiograph did not reveal any bony erosion.
Figure 1: Preoperative intraoral picture of the lesion

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Incisional biopsy was done, and the lesion was diagnosed as pleomorphic adenoma arising from the minor salivary glands in soft palate region after histopathologic examination and clinical correlation findings.

Treatment plan was formulated. Under general anesthesia, tumor excision with marginal clearance was done [Figure 2]a. Reconstruction of the soft palate defect after the tumor excision was done by using bipedicle rotational and advancement of palatal pedicle flaps [Figure 2]b, following which prefabricated surgical splint was placed.
Figure 2: (a) Excised tumor mass (b) Intraoperative picture after reconstruction

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The postoperative recovery was uneventful. The palatal splint was removed after 1 week. On reviewing the patient after 1 month, the reconstructed surgical defect with bipedicled rotation and advancement flaps were healing uneventfully [Figure 3].
Figure 3: One month postoperative intraoral picture

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Pleomorphic adenoma is a mixed salivary gland tumor originating from the epithelial and mesodermal elements. [1] It consists of acini, cords, and thin strands of epithelial cells suspended in a stroma which often has a myxomatous appearance. Pleomorphic adenomas are usually painless, slow-growing tumors. However, some cases exhibiting rapid growth have been reported. [2],[3],[4] Lopez-Ce-Drun et al. reported a case of pleomorphic adenoma in the palate of a 16-year-old male patient which was noted only 2 weeks before his presentation. [3]

Most cases of palatal pleomorphic adenoma cause not only a bulge in the palatal mucosa, but also erosion of the palatal bone as well. [5] In our case report, the patient presented with a painless swelling in the soft palate, which was noted 3 months before his presentation. There was no palatal bone erosion. There was no associated pain or bleeding or ulceration of the lesion. The noninvasive diagnostic aids for salivary gland tumors include ultrasound, computerized tomography, and magnetic resonance imaging. These are useful methods in determining the size of the lesion as well as verifying any bony involvement. [6],[7],[8] Overall, the prognosis for pleomorphic adenomas of minor salivary glands is generally considered to be better than that for those arising in the parotid salivary gland. [9] Treatment of pleomorphic adenoma in children is the same as that in adults. We did wide excision of the tumor with clear margins, followed by reconstruction of the defect created by the surgical excision.

The reconstruction technique used was bipedicled palatal rotation and advancement flap, which was used to cover the surgical defect. This technique is versatile for reconstruction of soft palatal defects created by surgical excision of the tumors. Hence, we conclude that this particular case report occurring in a young adolescent is rare and the technique used for reconstruction was versatile and at the same time simple to perform.

 
   References Top

1.Galich R. Salivary gland neoplasms in childhood. Arch otolaryngol 1969;89:100.  Back to cited text no. 1
    
2.Lack EE, Upton MP. Histopathologic review of salivary gland tumours in childhood. Arch Otolaryngol Head Neck Surg 1988;114:898.  Back to cited text no. 2
    
3.Lopez-Cedrum JL, Gonzalez- Landa G, Birichinaga B. Pleomorphic adenoma of the palate in children: Report of a case. Int J Oral Maxillofac Surg 1996;25:206.  Back to cited text no. 3
    
4.Shabaal H, Bruce J, Davenport PJ. Recurrent pleomorphic adenoma of the palate in a child. Br J Plast Surg 2001;54:245.  Back to cited text no. 4
    
5.De Courten A, Lombarbi T, Samsung J. Pleomorphic adenoma in a child: 9 yr follow up. Int J Oral Maxillofac Surg 1996;25:293.  Back to cited text no. 5
    
6.Noghreyan A, Gatot A, Maor E, Fliss DM. Palatal pleomorphic adenoma in a child. J Laryngol Otol 1995;109:343.  Back to cited text no. 6
    
7.Fonseca I, Martins AG, Soares J. Epithelial salivary gland tumour of children and adolescents in southern Portugal: A clinicopatholgic study of 24 cases. Oral Surg Oral Med Oral Pathol 1991;72:696.  Back to cited text no. 7
    
8.Austin JR, Crockett DM. Pleomorphic adenoma of the palate in a child. Head Neck 1992;14:58.  Back to cited text no. 8
    
9.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.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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