# Comprehensive perioperative and minimally invasive post-operative defect approach of massive palatal pleomorphic adenoma: Case series

## TL;DR

This case series presents a minimally invasive surgical approach for treating large palatal tumors, focusing on preserving function and achieving good outcomes.

## Contribution

A novel, step-by-step approach for managing massive palatal pleomorphic adenoma with minimal invasiveness and good functional outcomes.

## Key findings

- Two female patients with massive palatal pleomorphic adenoma were successfully treated with minimal invasive surgery.
- Local ostectomy preserved vital structures, and surgical obturators aided in wound healing without complications.
- No recurrence or speech impairment was observed post-surgery.

## Abstract

Extensive Palatal post-operative defect management following excision of neoplasm is one of the most difficult challenges for oral and maxillofacial surgeons regarding its limited surgical access and visibility on narrow area, airway management difficulty during intubation, richness of maxillary vascular network resulting in enormous bleeding risk. Decision making regarding its surgical approach and impact on speech and mastication is important. This case series aim to describe comprehensive step by step perioperative and palatal defect management approach based on tumor pathological characteristic and anatomical perspective to achieve good surgical outcome.

Two cases of massive palatal pleomorphic adenoma were presented. Both of cases occurs in female patients. Lesions was crossing the midline, impair speech and causing discomfort. Preoperative diagnostic from CT scan and FNAB result was pleomorphic adenoma.

Surgery for both cases done with wide periosteal sacrificing excision, ostectomy and surgical obturator placement from intraoral approach under general anesthesia with nasal intubation. Eventually the wounds healed without wound dehiscence and fistula, no speech impairment and no sign of reccurency.

Understanding pathological characteristic of pleomorphic adenoma and basic anatomy of surrounding structure are important to formulate minimal invasive surgical and post-operative defect management planning and improve patient's quality of life.

•Pleomorphic adenoma in palate with enormous size was treated with minimal invasive surgical approach•Treatment approach was based on deep comprehension of basic medical science such as wound healing mechanism•Local ostectomy was done instead of infrastructure maxillectomy to preserve vital structure•Obturator was placed to protect the underlying secondary wound healing and achieve excellent wound healing

Pleomorphic adenoma in palate with enormous size was treated with minimal invasive surgical approach

Treatment approach was based on deep comprehension of basic medical science such as wound healing mechanism

Local ostectomy was done instead of infrastructure maxillectomy to preserve vital structure

Obturator was placed to protect the underlying secondary wound healing and achieve excellent wound healing