Excision of the hard palate due to tumor and plasty with a temporal patch: a case report : [tarptautinis pranešimas]
| Date |
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2023-05-06 |
Session C - Student's approach to trauma, orthopedics, plastic and reconstructive surgery
Jury members: G. Kvedaras, D. Stundys
Introduction. Squamous cell carninoma of the sinonasal tract is relatively rare and morphologically and genetically heterogenous. Case report. A 65-year-old man complained of pain with pulsation in the right temple, insomnia, swelling of the right eye and cheek. Magnetic resonance imaging (MRI) revealed a tumor of the right maxillary sinus which spread to the retrobulbar space. A biopsy was taken during unilateral intranasal buccal antrostomy and showed poorly differentiated non-keratinizing squamous cell carcinoma (NK SCC) G3. After chemoradiotherapy, computed tomography (CT) revealed signs of tumor progression in the right buccal cavity, however a biopsy showed fibrosis without neoplastic changes. After 9 months, the patient complained of right cheek inflammation, rhinorrhea. Nasal endoscopy showed small remaining tumor tissue, predominantly in the maxilla. A biopsy revealed infiltrative SCC. MRI demonstrated progression of the oncological process. Biopsy taken from the walls of the buccal sinus and the palate, which showed infiltrative SCC. Right maxillectomy (type IIb according to Brown) was performed. A biopsy was taken from the hard palate indicating spread of SCC. Multidisciplinary team concluded to perform tumor excision with cytobiopsies. Palatoplasty with a temporal patch could be made only in the presence of a radical resection margin. Based on urgent histology, the scope of the operation was expanded to remove the tumour radically. 2 months after surgery the patient is in good condition and is able to eat, drink without sustenance entering the nose. Discussion. Transposition of the temporal muscle patch was performed through the formed channel under the zygomatic bone into the oral cavity. Plasty of the defect was performed by sewing the patch to its edges. Conclusions. We present a case of 65-year-old patient with SCC of the sinonasal tract. Treatment strategies consist of chemoradiotherapy, surgery or a combination of both.