Massive pleomorphic adenoma of the soft palate.

We evaluated a 24-year-old Korean woman (an exchange student) in the clinic setting who complained of abnormal speech and dysphagia with certain solids. Examination identified a large soft-palate tumor (figure 1). Magnetic resonance imaging (Mill) confirmed that the tumor originated in the oropharynx but did not extend into the parapharyngeal space (figure 2). Findings on transoral fine-needle aspiration biopsy of the mass were consistent with a pleomorphic adenoma. The patient underwent transoral submucosal resection via a midline soft-palate-split approach (figure 3). Grossly, the tumor was well encapsulated and measured approximately 4 cm (figure 4). Postoperatively, the patient's speech and swallowing function returned to normal, and there was no significant alteration of the soft-palate anatomy (figure 5).

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Pleomorphic adenomas are benign heterogenous tumors of salivary gland origin. They are made up of myoepithelial and epithelial components. In most cases, these tumors arise in the major salivary glands (e.g., the parotid). When they occur in the minor salivary glands, the most common site is the palate, followed by the lip. Palatal tumors are typically slow growing and painless for many years until they become large enough to affect mastication or respiration. Complete surgical excision is the treatment of choice. Imaging should be performed prior to attempting a transoral surgical approach to rule out parapharyngeal space origin or extension. In such a case, an external approach would provide better exposure and allow for control over the great vessels and regional cranial nerves.

Suggested reading

Bataineh AB, al-Dwairi ZN. Surgical management of pleomorphic adenoma of the palate. J Ir Dent Assoc 2002;48:126-31.

Lomeo P, Finneman J. Pleomorphic adenoma of the soft palate. Otolaryngol Head Neck Surg 2001 ; 125:122.