Srivanitchapoom Chonticha, Yata Kedsaraporn
Otolaryngology Unit, Phayao Hospital, Phayao, Thailand.
Ann Med Surg (Lond). 2023 Nov 16;86(1):525-529. doi: 10.1097/MS9.0000000000001514. eCollection 2024 Jan.
Mucoepidermoid carcinoma (MEC) ex pleomorphic adenoma is a rare type of salivary gland cancer. Surgical resection remains the standard therapy for this malignancy. After tumor removal, larger defects may require a local, regional, or free flap, while smaller ones can be closed primarily. Managing medium-sized defects can be challenging, especially on the buccal mucosa.
A 47-year-old man had a buccal mucosa mass for 10 years, which gradually grew over a year and irritated his chewing. A 2.2×2 cm buccal mass was observed with telangiectatic and erythematous alterations in the surrounding mucosa. The preoperative tissue biopsy suggested salivary gland malignancy. The patient underwent surgical excision and a single-stage buccal advancement flap reconstruction, successfully closing the 4 cm defect. The final diagnosis was MEC ex pleomorphic adenoma. He reported mild discomfort during the first few months while opening his mouth. The patient had fully recovered after 6 months.
This is the first case of MEC arising in a pleomorphic adenoma of the buccal mucosa. For low-grade and small-sized tumors, a single modality is appropriate for treatment. Local flaps such as buccal fat pad or musculomucosal flap can repair medium-sized defects. However, the buccal advancement flap provides effective functional and esthetic benefits, optimal healing conditions, and reduces complications risk.
The buccal advancement flap is a valuable option for reconstructing medium-sized buccal defects up to 4 cm. The single-stage surgical procedure has been proven to yield minimal complications and provide a favorable outcome.
多形性腺瘤恶变的黏液表皮样癌（MEC）是一种罕见的涎腺癌类型。手术切除仍然是这种恶性肿瘤的标准治疗方法。肿瘤切除后，较大的缺损可能需要局部、区域或游离皮瓣修复，而较小的缺损可直接缝合。处理中等大小的缺损可能具有挑战性，尤其是在颊黏膜处。
一名47岁男性颊黏膜肿物10年，在一年中逐渐增大并影响咀嚼。观察到一个2.2×2厘米的颊部肿物，周围黏膜有毛细血管扩张和红斑改变。术前组织活检提示涎腺恶性肿瘤。患者接受了手术切除及一期颊部推进皮瓣重建，成功闭合了4厘米的缺损。最终诊断为多形性腺瘤恶变的黏液表皮样癌。他在术后最初几个月张嘴时报告有轻度不适。6个月后患者已完全康复。
这是首例发生于颊黏膜多形性腺瘤的MEC。对于低级别和小尺寸肿瘤，单一治疗方式是合适的。局部皮瓣如颊脂垫或肌黏膜瓣可修复中等大小的缺损。然而，颊部推进皮瓣提供了有效的功能和美学益处、最佳的愈合条件，并降低了并发症风险。
颊部推进皮瓣是修复长达4厘米的中等大小颊部缺损的一个有价值的选择。一期手术已被证明并发症最少且效果良好。
