Pleomorphic Adenoma of the Minor Salivary Gland on the Palate

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Pleomorphic Adenoma of the Minor Salivary Gland on the Palate

   

Jeremias Roman1, Romina Testi2, Jonathan Bavaro3 and Christian Mosca4*

1Dentist from UNLP. Interim Dentist of the Interzonal General Acute Hospital Pte. Perón

2UBA dentist. Interim of the Dentistry Service of the HIGA Presidente Perón Avellaneda Hospital.

3Dentist from UNLP. Staff dentist, teaching coordinator and head of the prosthetics unit at the Hospital Interzonal General de Agudos Pte. Perón

4UBA Dentist. Specialist in Surgery and Traumatology BMF. Doctor in Public Health. Associate Professor of the UNO Microbiology and Parasitology Subject. Professor of the Subject Infectology of the Esp of CBMF UMAI. Associate Professor of Microbiology and Immunology UK. Advisory Professor of HIGA Pte Perón

*Corresponding author: Christian O. Mosca, General Venancio Flores 4567, Cuidad Autonoma de Buenos Aires. Argentina.          

Citation: Roman J, Testi R, Bavaro J, Mosca C. Pleomorphic adenoma of the minor salivary gland on the palate. J Oral Med and Dent Res. 5(2):1-10.

Received: May 25, 2024 | Published: June 13, 2024

Copyright© 2024 genesis pub by Roman J, et al. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

DOI: https://doi.org/10.52793/JOMDR.2024.5(2)-56  

Abstract

Pleomorphic adenoma is the most common benign tumor of the salivary glands. Its main location is in the parotid gland, with minor glands being less common; but when it appears in the latter, the palate is its most common location. This publication presents a case of a 27-year-old female patient who attended the Dentistry Service of the Presidente Perón de Avellaneda General Acute Interzonal Hospital, presenting with a swelling in the upper right palate at tooth level 1.6. She underwent surgery and the pathological result confirmed the diagnosis of pleomorphic adenoma of the minor salivary gland. This tumor is rare in the minor salivary glands and represents 15-23% of all glandular neoplasms.

Keywords

Pleomorphic adenoma; Salivary gland; Palate; Tumor

Introduction

Tumors of the minor salivary glands are rare, accounting for 2% to 4% of head and neck tumors, 10% of benign neoplasms of the oral cavity, and 15% to 23% of all salivary glands [1]. Pleomorphic adenoma grows slowly, with signs and symptoms that may vary depending on the anatomical site affected, but are mostly painless. It is considered a benign neoplasm [2] and is generally located in the parotid glands (85%), and the submandibular glands (5%). In most cases, tumors originate in the superficial lobe. However, in specific cases it can affect the deep lobe of the parotid gland and the parapharyngeal space. Among the minor salivary glands, the palate is considered the most common intraoral site, followed by the lip, cheek, tongue, and floor of the mouth [3-6]. Pleomorphic adenoma of the minor salivary glands occurs mainly between the fourth and sixth decade of life, with a slight predominance in women [7]. It is also classified as the most common salivary gland neoplasm in children [8]. Clinically, they are characterized by being painless, well-defined and covered with a normal mucous membrane, with ulcerations being observed in some cases. Tumors of the major glands are usually encapsulated, unlike tumors of the minor glands [9]. As its name indicates, it has a mixed histology and consists of 3 components: epithelial, myoepithelial and stromal (mesenchymal). It is also known as a benign mixed tumor, which describes its pleomorphic appearance on light microscopy with an origin from epithelial and myoepithelial elements [10]. The therapeutic approach for this type of neoplasms in minor salivary glands is wide local excision with removal of the periosteum and the affected bone [9-12].  The potential risk of malignancy of Pleomorphic Adenoma is around 6% [13-16].

For this research, the patient's rights were fundamentally protected, under the consent signed by the patient and the authorization in the teaching area of the Hospital Interzonal General de Agudos Gral Perón, respecting the ethical principles based on the Declaration of Helsinki.

Clinical Situation

A 27-year-old female patient presented at the Dentistry service of the Presidente Perón General Acute Interzonal Hospital in Avellaneda. The patient's clinical history and anamnesis revealed a swelling in the hard palate on the right side, radiating to the soft palate, lasting 6 months. No systemic history reported (Figure 1).

Figure 1: Preoperative photograph of the patient where you can see the swelling on the hard palate between teeth 1.5 to 1.7

Figure 2: Panoramic radiography. In it you can see the root rest of tooth 1.6, in which the presumptive diagnosis was an infectious condition.

where penetrating caries was observed in tooth 1.6 and with a probing depth of 9 mm. Upon extraoral and intraoral clinical inspection, a 4x3cm tumor on the hard palate, of indurated consistency, immobile and painless on palpation, with slight invasion of the ipsilateral soft palate, was observed at the level of tooth 1.6 and 1.7, both with mobility, with normal coloring and defined edges. In the clinical cervicofacial examination, no clinical signs of lymphadenopathy were observed. Based on the clinical radiographic diagnosis, an infectious swelling due to tooth 16 was presumed to be present. For this reason, an aspiration puncture of the swelling was performed to confirm the presence of pus, the result being negative. Taking the clinical radiographic parameters, the extraction of teeth 16 and 17 was planned, and the approach to the exploratory tumor lesion.

Surgical procedure

Under preoperative antibiotic prophylaxis of Amoxicillin 875mg + Ac. Clavulanic acid 125 mg, extraction of teeth 1.6 and 1.7 and total excision of the tumor was carried out, under local anesthesia, Carticaine 4% - adrenaline 1:100,000. The surgical field was antisepsised with 10% povidone iodine, anesthesia of the posterior dental and posterior palatine nerves, and preparation of the surgical field. Intracrevicular incision with Bad-Parker No. 3 scalpel and No. 15 blade, to pieces 1.6 and 1.7; extractions themselves with a straight clevdent-type elevator and upper molar clamps; muco-periosteal curettage of palatine mucosa.

At the time of clinical examination of the tumor, it is palpable that it is firmly adhered to the periosteal plane. The tissues continue to be disseminated until total enucleation is achieved. A hard, firm, encapsulated tumor approximately 1.5 cm in diameter can be observed (Figure 3,4).