Navigation-Guided Resection of a Mucoepidermoid Carcinoma in the Pterygopalatinal Fossa

Purpose: Mucoepidermoid carcinoma is the most common histotype of malignant and benign salivary gland tumors; in addition to their ordinary derivation from the major and minor salivary glands of the head and neck regions, they occasionally arise within the facial bones of the mandible and maxilla. The frequency is averaged out to be 22% of all salivary gland tumors. The treatment of choice is surgical resection and, depending on malignancy, postoperative radiochemotherapy.

Method: We present a case of a 48-year-old woman who suffered from a mucoepidermoid carcinoma primarily at the hard palate that extended to the pterygopalatinal fossa and reached the optic nerve. For diagnostic imaging, MRI and CT scans were performed. For planning of the surgical procedure, image fusion of MRI and CT scans was conducted using a 3D imaging software.

Result: Intraoperatively, navigation-controlled resection of the tumor in safety margins was done using computer-assisted surgery. The whole tumor was resected. Major anatomical structures like the optic nerve, skull base, and the sinus cavern could be preserved. Histologically, the tumor presented as a high-grade mucoepidermoid carcinoma. Postoperatively, the patient was treated by adjuvant radiochemotherapy. Up to now, the patient has had no recurrence of the tumor.

Conclusion: Surgical resection of a mucoepidermoid carcinoma is the treatment of choice. Especially in anatomically complicated regions of the head, preoperative planning of surgical treatment is very helpful using 3D images to get more information about the tumors' dimension and resection in safety margins.