Guided Limited Maxillectomy and Staged Septal–Palatal Reconstruction for Low-Grade Chondrosarcoma of the Hard Palate: A Case Report and Literature Review

TL;DR

A rare case of hard palate chondrosarcoma is treated with a two-stage surgical approach, achieving successful tumor removal and reconstruction.

Contribution

Presents a novel two-stage surgical technique for low-grade chondrosarcoma involving guided maxillectomy and staged flap reconstruction.

Findings

Image-guided maxillectomy achieved clear tumor margins with minimal invasiveness.

Staged reconstruction using nasal and palatal flaps restored function and appearance effectively.

The approach minimized complications and provided excellent oncologic and functional outcomes.

Abstract

Chondrosarcoma of the maxillofacial skeleton is a rare malignant tumor characterized by cartilaginous differentiation and locally invasive growth. Diagnosis is particularly challenging in low-grade tumors because histological features often overlap with those of benign chondroma. We describe a 62-year-old woman with a recurrent cartilaginous tumor of the hard palate. After previous resections in 2013 and 2022, a third recurrence was detected. MRI showed a lobulated lesion at the anterior hard palate contiguous with the nasal septum. A two-staged treatment was performed, starting with a minimal invasive access Brown class 2a maxillectomy guided by a patient-specific cutting guide. Pending histological confirmation, an obturator prosthesis was placed to seal the oroantral communication. Histopathology confirmed a low-grade chondrosarcoma with clear margins of at least 5 mm. A second-stage reconstruction was performed a year later using a posterior pedicle lateral nasal wall flap (inferior turbinate flap) and palatal rotation flap restored nasal lining and oral mucosa. This approach achieved oncologic clearance with excellent functional outcomes. The case highlights the value of image-guided maxillectomy and staged regional flap reconstruction.

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