Using the Le Fort I approach in removing a palatal mucoepidermoïd carcinoma

Abstract

Mucoepidermoïd carcinomas are a relatively uncommon type of malignancy of the head and neck region. Traditionally, they are classified into low-, intermediate- and high-grade lesions by the WHO which reflect clinical behaviour. However, this classification remains a point of discussion with alternative classifications at hand. Surgery is the preferred treatment and is combined with radiotherapy in high grade lesions or specific situations.In this case report, a case of a mucoepidermoïd carcinoma (MEC) of the right hard palate in a 36-year old patient is presented. The lesion, however, was first diagnosed as a benign cystic lesion after which a mucoepidermoïd carcinoma was found within on histopathological examination. The malignancy was surgically removed including the underlying palatal bone and the greater palatine canal guided by a Le Fort I approach. This approach offers direct visualisation of the resection margins and the canalis pterygopalatina. Reconstruction was carried out by using an ipsilateral buccal fat pad flap, leucocyte and platelet rich fibrin membranes (L-PRF). The remaining defect was covered by a palatal cover plate afterwards. In this report, we add detailed illustrations of the surgical approach in which the important anatomical landmarks are pictured. Keywords: Mucoepidermoid carcinoma, Surgery, Le Fort I osteotomy, Palate