Endoscopic-Assisted Resection of Palatal Mucoepidermoid Carcinoma with Preservation of the Nasal Floor Mucosa

Mucoepidermoid carcinoma represents the most common primary salivary gland malignancy overall, and the most common salivary gland malignancy in children and adolescents, with a female predilection. Among minor salivary gland cancers, the hard palate represents one of the most common subsites involved. Surgical resection with clear margins is the treatment of choice, with a low risk of recurrence for low- to intermediate-grade cancers. We present a case of mucoepidermoid carcinoma of the hard palate in a 19-year-old patient, who underwent transoral, endoscopic-assisted resection of the lesion with preservation of the nasal cavity floor mucosa.

A 19-year-old female college student presented to her dentist after noting a “bump” in her right hard palate. She was subsequently referred to an oral surgeon, who performed an incisional biopsy which revealed low-grade mucoepidermoid carcinoma. Physical examination was notable for an approximately 1.5 × 1.5 cm erythematous submucosal lesion in the right posterior hard palate. Computed tomography showed a mildly enhancing lesion with focal osseous dehiscence of the palate. The patient underwent wide resection with partial palatectomy ([Figs. 1] [2] [3]). A 30-degree rigid endoscope was utilized to improve visualization of the lesion and resection margins and to assist in preservation of the mucosa of the nasal floor ([Fig. 4]) during bone removal of the en bloc specimen. Prior to the palatectomy, the nasal floor was infiltrated with saline to elevate the mucosa off the nasal floor via hydrodissection. Surgical pathology revealed a 7-mm intermediate-grade mucoepidermoid carcinoma without lymphovascular or perineural invasion. The resection margins were negative. The surgical defect was lined with an acellular collagen matrix graft (Alloderm), which was secured with bacteriostatic petrolatum gauze and a palatal obturator. At her one-month postoperative visit, the surgical defect was healing well by secondary intention and there was no evidence of oronasal fistula.

While there is no definitive evidence as to whether bony resection is required for small, low-to-intermediate grade tumors of the hard palate, lesions with radiographic evidence of bony involvement require partial palatectomy in addition to soft tissue resection. In this case, the patient’s age and functional status necessitated an approach that would result in resection with negative margins and minimize postoperative morbidity. The endoscope was crucial in allowing preservation of the nasal floor mucosa to prevent postoperative sequelae, specifically oronasal fistula.

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