Surgical Excision of Polymorphous Adenocarcinoma in the Left Maxilla with Mucous Flap Reconstruction

Background and Aim: Low-grade polymorphous adenocarcinoma is a rare malignancy originating in the salivary glands, with infrequent occurrence in the head and neck region. Typically, this condition is more prevalent among elderly females, predominantly in their sixth to eighth decades of life, with a greater propensity for affecting the hard and soft palate. The primary treatment of choice for this malignancy is an extensive surgical excision, often necessitating the removal of underlying bone. This study aims to present a case report detailing the surgical excision of a polymorphous adenocarcinoma in the maxilla, followed by mucous flap reconstruction.
Method: A 63-year-old male patient presented with a tumor-like lesion in the left maxilla, which had been gradually increasing in size. Upon intra-oral clinical examination, findings revealed the presence of upper and lower total dentures, an enlarged mass in the left maxillary tuberosity region, and a nodular lesion characterized by a fibrous and smooth consistency. The lesion appeared fixed, sessile, oval in shape, with well-defined edges, and was devoid of pain.
Results: Radiographic assessment via panoramic radiography depicted a lesion with mixed radiographic density situated in the left maxillary tuberosity region. Computed tomography scans were further conducted and employed for 3D image reconstruction. An axial tomographic view confirmed the presence of a heterogeneous lesion with evidence of osteolysis, alterations in cortical and trabecular bone, and reabsorption of the left palatine bone, all with regular contours and clearly defined edges. Given the extent and complexity of the lesion, the surgical approach in this case involved a hemimaxillectomy, followed by mucosal flap reconstruction. The postoperative period was uneventful, adhering to standard service protocols, with no complications or signs of recurrence. The surgical specimen was sent to the Anatomopathological Service, where the diagnosis was confirmed with clear margins.
Conclusion: Low-grade polymorphous adenocarcinoma is an exceptionally rare malignancy affecting the salivary glands, characterized by relatively low potential for malignancy, recurrence, and metastasis. This case underscores the importance of timely diagnosis and appropriate surgical intervention in achieving favorable treatment outcomes and mitigating the risk of disease progression.