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      Coblator-Assisted Endoscopic Transnasal Resection of a Large Nasopharyngeal Pleomorphic Adenoma

      case-report

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          Abstract

          Background

          Pleomorphic adenomas occurring in the adult nasopharynx are rare, with our literature search identifying only 11 previous English-language reports. We document the unusual case of a large nasopharyngeal pleomorphic adenoma that was resected using radiofrequency coblation via an endoscopic transnasal approach.

          Methods

          A 39-year-old male presented with worsening nasal congestion, intermittent otalgia, and a progressive change in voice. Flexible nasendoscopy showed a large homogeneous mass occupying the postnasal space, and computed tomography confirmed a 28 × 31 × 22 mm nasopharyngeal tumour. The biopsy-proven benign tumour was locally dissected using a coblator-assisted transnasal approach.

          Results

          Histology confirmed complete excision of a myoepithelial-rich pleomorphic adenoma. The patient was symptom-free postoperatively, and no signs of recurrence were seen at one-year follow-up.

          Conclusions

          This is a useful addition to the existing literature on surgical procedures used to treat benign pathology in the nasopharynx. The minimally invasive technique was well tolerated and had favourable patient outcomes.

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          Most cited references15

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          Management of Salivary Gland Tumours: United Kingdom National Multidisciplinary Guidelines

          S. Sood, M McGurk, F. Vaz (2016)
          This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. Salivary gland tumours are rare and have very wide histological heterogeneity, thus making it difficult to generate high level evidence. This paper provides recommendations on the assessment and management of patients with cancer originating from the salivary glands in the head and neck. Recommendations • Ultrasound guided fine needle aspiration cytology is recommended for all salivary tumours and cytology should be reported by an expert histopathologist. (R) • Adjuvant radiotherapy (RT) following surgery is recommended for all malignant submandibular tumours except in cases of small, low-grade tumours that have been completely excised. (R) • For benign parotid tumours complete excision of the tumour should be performed and offers good cure rates. (R) • In the event of intra-operative tumour spillage, most cases need long-term follow-up for clinical observation only. These should be raised in the multidisciplinary team to discuss the merits of adjuvant RT. (G) • As a general principle, if the facial nerve function is normal pre-operatively then every attempt to preserve facial nerve function should be made during parotidectomy and if the facial nerve is divided intra-operatively then immediate microsurgical repair (with an interposition nerve graft if required) should be considered. (G) • Neck dissection is recommended in all cases of malignant parotid tumours except for low-grade small tumours. (R) • Where malignant parotid tumours lie in close proximity to the facial nerve there should be a low threshold for adjuvant RT. (G) • Adjuvant RT should be considered in high grade or large tumours or in cases where there is incomplete or close resection margin. (R) • Adjuvant RT should be prescribed on the basis of clinical factors in addition to histology and grade, e.g. stage, pre-operative facial weakness, positive margins, peri-neural invasion and extracapsular spread. (R)
          Article 0 comments Cited 65 times – based on 0 reviews     Review now
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            Malignancy in pleomorphic adenoma. A clinical and microspectrophotometric study.

            A Zetterberg, C Eneroth (1974)
            Article 0 comments Cited 11 times – based on 0 reviews     Review now
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              Nasopharyngeal pleomorphic adenoma in the adult.

              Siobhan Kuhar, Louisa Lee, Nelson Lee … (2006)
              Salivary gland tumors account for less than 5% of all neoplasms in the head and neck, with pleomorphic adenoma being the most common type. These typically arise in the palate, but we report a rare case of nasopharyngeal pleomorphic adenoma in an adult. The authors conducted a case report and literature review. The patient presented with unilateral otalgia, tinnitus, and aural fullness. Nasal endoscopy revealed a pedunculated mass adjacent to the left torus tubarius and he was treated with an excisional biopsy. Histologic evaluation demonstrated pleomorphic adenoma. Pleomorphic adenomas seldom present as nasopharyngeal masses and have a nonspecific appearance on endoscopy. Microscopic examination has characteristic features to aid in an accurate diagnosis. Treatment is surgical and recurrence is unlikely.
              Article 0 comments Cited 8 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jonathan Bowman:
                ORCID: http://orcid.org/0000-0001-8322-3223
                Journal
                Journal ID (nlm-ta): Case Rep Otolaryngol
                Journal ID (iso-abbrev): Case Rep Otolaryngol
                Journal ID (publisher-id): CRIOT
                Title: Case Reports in Otolaryngology
                Publisher: Hindawi
                ISSN (Print): 2090-6765
                ISSN (Electronic): 2090-6773
                Publication date Collection: 2019
                Publication date (Electronic): 27 February 2019
                Volume: 2019
                Electronic Location Identifier: 4654357
                Affiliations
                1University of Manchester, Manchester, UK
                2Royal Blackburn Teaching Hospital, Blackburn, UK
                Author notes

                Academic Editor: Marco Berlucchi

                Author information
                http://orcid.org/0000-0001-8322-3223
                Article
                DOI: 10.1155/2019/4654357
                PMC ID: 6415314
                SO-VID: 1692fde0-0bd6-4413-9f89-bec57395fadf
                Copyright © Copyright © 2019 Jonathan Bowman et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 November 2018
                Date accepted : 3 February 2019
                Categories
                Subject: Case Report

                Data availability:

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