A 67-year-old woman presented to our service with swelling in the posterior region of the right hemipaladar.
A biopsy was performed under local anesthesia with the diagnosis of PLGA.
Cervical examination showed lymphadenopathy at the right submandibular level.
The most relevant antecedent was radiotherapy in childhood for a non-scheduled pathology in the head and neck region.
Orthopantomography was normal.
A cervicofacial computerized tomography was requested and reported as a lesion at the level of the right nasal fossa in stage IV (T4N2CMx).
A cytological puncture of the submandibular adenopathy was performed, reporting probable ALP.
MRI shows a well-defined lesion in the nasal fossa extending to the pterygoid region.
1.
Surgery was decided under general anesthesia.
The tumor was approached by a Lefort I type maxillotomy. Unilateral suprahomohyoid cervical lymph node dissection was also performed.
Tumor resection and bone replacement of the maxilla were performed using preconformed miniplates of 1.5 mm.
1.
The definitive result of the pathological anatomy confirmed the diagnosis of PLGA, with invasion of surgical margins at the level of the right pterygomaxillary area.
Metastatic hyperplasia detected lymphadenopathies on the right side (5).
1.
The patient was presented in the maxillofacial surgery session - Ongoing radiation therapy session adjuvant in the right pterygium region and follow-up MRI imaging controls.
Given the persistence of tumor remnants it was decided to expand surgical margins at the right pterygomaxillary level and reconstruction of the defect by means of oral fat ball Bichat.
Two years later, the patient is under regular monitoring and disease-free.
