ABORDAJE TRANSMANDIBULAR EN ADENOCARCINOMA DE GRAN TAMAÑO DE BASE DE LENGUA

Abstract

Introduction: Globally, salivary gland tumors represent between 2 and 6.5% of all head and neck tumors. The most frequent location is in the parotid gland and 9-23% are located in the minor salivary glands. Low-grade polymorphic adenocarcinoma is an epithelial tumor that is almost exclusive to the minor salivary glands, the most frequent location of this tumor is the hard palate but it can occur in any minor salivary gland.Material and methods: A 70-year-old woman who comes to the emergency room due to a tumor on the right side of the tongue, not painful, that she had noticed 3 days ago. The examination shows a stone mass, on the right region of the tongue base. The neck is normal. A biopsy is performed on the patient and a cervical MRI is requested.Results: The result of the biopsy was the following: polymorphous adenocarcinoma of low grade of minor salivary glands. MRI: Tumor centered on the right side of the tongue with approximate maximum diameter of 4.8 x 3.8 x 3.7 cm. The patient was programmed for the surgical intervention and was performed: first, tracheotomy with local anesthesia and then a partial glosectomy of the base of the tongue using a transmandibular approach paramedian on the right side and a mandibular osteosynthesis. The patient was discharged 22 days after the surgery, decanulated and without a nasogastric tube due to the absence of respiratory compromise and with good oral tolerance. The final result of the pathological anatomy was polymorphous adenocarcinoma of minor salivary glands that respects the excisional surgical borders. The patient was then referred to radiation oncology to complete her treatment.Conclusions: Planning treatment in a patient with a malignant tumor of the oropharynx will depend on many factors such as: the location of the tumor, the size, the affectation of the jaw, and other factors such as the patient's general condition, age or teething condition. These factors will also affect the choice of the surgical approach if surgery is indicated. The transmandibular approach is a classic approach for tumors such as this one, located at the base of the tongue that provides a broad field and, therefore, good control of neurovascular structures. However, it has a number of disadvantages because it requires to section the lip with the consequent facial scar and also the surgical area tends to bleed. Low-grade polymorphic adenocarcinomas have a prognosis as low-grade tumors as their name suggests, with 12% recurrence, regional lymph node metastases of 10% and mortality less than 2%.