A 53-year-old Caucasian male patient with no history of interest came to the Emergency Department of the Hospital for prolonged dysphagia and recent dysneic sensation that worsened in supine position.
Upon inspection, a mass appears to depend on the palate, indurated and painless to ventral consolidation, not friable and with a superficial ulcer on the face.
The mass compresses the tongue against the floor of the mouth hindering its mobility.
No significant lymphadenopathy was found.
There is no involvement of lower cranial nerves (IX, X, XI and XII).
Facial sensitivity is preserved.
Nasofibroscopy showed a globulose tumor occupying most of the nasopharynx and oropharynx, predominantly in the left ear, and in the supine position it was difficult to see the posterior pharyngeal wall.
The rest of the ENT examination was normal.
Maxillofacial CT images show a hypodense 10x 8.5x 5.6 cm tumor involving the oral cavity, oropharynx and lower portion of the cavum.
The tumor affects mainly the buccinator muscles and pterygoid muscles, as well as the gingival region, soft palate and gastrointestinal region.
There is also mandibular and maxillary erosion adjacent to the level of the inferior face of the left maxillary sinus.
Adenopathies of non-significant size in areas I, II and III bilateral cervical.
MRI shows hypointense lesion in T1 and hyperintense lesion in T2, dependent on the palate that displaces and compresses, distorting the pharyngeal morphology.
Biopsy is reported as pleomorphic adenoma.
Immunohistochemistry is positive for cytokeratin, S100 protein and muscle-specific actin.
The patient is intubated endonasally to facilitate surgical maneuvers and the impossibility of oral intubation.
Median transoral approach, after checking the oral opening and through a Davis Boyle mouth opener, complete excision of the tumor with a hard palate tumor free resection margins for tumor is performed.
The postoperative period is uneventful, and one year later the patient is asymptomatic and without clinical evidence of injury.
