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Polymorphous Low-Grade Adenocarcinoma

A Proposed Reconstruction Protocol Based on Past Surgical Experience

Gottlieb, Jonathan B., DMD, FRCS*; Joachim, Michael, DMD, MSc*; Leiser, Yoav, MD, PhD; Abdelraziq, Murad, MD, DMD*; Abu El-Naaj, Imad, DMD*,‡

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1228–1230
doi: 10.1097/SCS.0000000000005328
Clinical Studies

Background: To propose a reconstructive protocol based on surgical management experience of polymorphous low-grade adenocarcinoma (PLGA) and the location of the primary lesion.

Methods: Data on the surgical management and the reconstructive technique of 14 histologically conformed patients with PLGA, all treated by the same surgeon, were analyzed and evaluated.

Results: Mean follow-up period in our series was 6.2 years. Mean age at diagnosis was 55.5 years and female to male ratio was 2.2:1. The most common presenting sign was a nonpainful lump or mass in an intraoral location. Most patients were managed by wide local excision and reconstruction method varied from primary closure to the use of radial forearm graft. Recurrence appeared in one of the patients in this series, while 2 required further radiation therapy. A protocol for reconstruction of intraoral patients with PLGA is suggested based on our analysis.

Conclusion: Surgical management is the gold standard for PLGA treatment. Neck dissection is recommended only in patients with presurgery fine-needle aspiration confirmed lymph node involvement. The reconstruction depends mainly on location and size of the primary lesion.

*Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya

Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa

Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.

Address correspondence and reprint requests to Michael Joachim, DMD, MSc, Resident, Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Poriya, MP Lower Galilee, Israel; E-mail:

Received 8 October, 2018

Accepted 20 December, 2018

Ethics approval was waived by the institutions involved.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.