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Buccal Myomucosal Flap Reconstruction After Resection of Palatal Mucoepidermoid Carcinoma

Kimia, Rotem BS; Shakir, Sameer MD; Jackson, Oksana A. MD; Nguyen, Phuong D. MD, FACS, FAAP

doi: 10.1097/SAP.0000000000001949
Head and Neck Surgery: PDF Only
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Salivary gland tumors are rare, constituting approximately 0.5% of pediatric malignancies, yet account for over 50% of malignant salivary gland neoplasms, of which a majority are mucoepidermoid carcinomas (MECs). We present a case of MEC involving the palatal minor salivary gland of an adolescent patient successfully reconstructed using buccal myomucosal flap. The subject presented as a 17-year-old male with a painless left hard palatal mass found to have imaging suspicious for minor salivary gland tumor and punch biopsy consistent with a low-grade MEC. The subject underwent wide local excision of a 1.0 × 1.2 cm mass with 1.0 cm margins down to hard palate nasal mucosa excluding the abutting first and second molars of the ipsilateral maxilla. Pathology confirmed low-grade MEC confined to hard palate. Two weeks, thereafter, the subject underwent buccal myomucosal flap reconstruction inset into the palatal defect and divided 2 weeks thereafter. Postoperative course was complicated by a pinpoint oronasal fistula at the posterior aspect of the flap-palate junction requiring reelevation and advancement. The subject subsequently recovered without complication. Mucoepidermoid carcinomas represent rare, malignant minor salivary gland tumors with nonspecific presentations that require multidisciplinary workup and management. The authors recommend reconstruction of resultant palatal defects to prevent progression to oronasal fistulae or speech and swallow impairment.

From the Division of Plastic Surgery, Department, of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.

Received January 10, 2019, and accepted for publication, after revision March 4, 2019.

Conflicts of interest and sources of funding: none declared.

Reprints: Phuong D. Nguyen, MD, FACS, FAAP, Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, 3615 Civic Center Blvd, Rm 130, Philadelphia, PA 19104. E-mail: pdnguyendoc@gmail.com.

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