Juvenile pleomorphic adenoma of masticator space: The first case report
A 16-year-old female patient reported to our department with the complaint of swelling in the left cheek region since 6 months. The swelling was nonpainful and was not associated with any toothache or discharge or any secondary changes []. Intraoral examination revealed a small swelling causing left buccal vestibular obliteration, extending from distal side of second premolar to maxillary tuberosity []. Computed tomography (CT) showed a hyperdense soft-tissue mass in the left masseteric space without involvement of any hard tissue. Magnetic resonance imaging (MRI) revealed a well-defined smooth capsular outlined left masticator space lesion []. The lesion was located lateral to left pterygomaxillary fissure and abutting lateral margin of alveolar arch of maxilla. Posterior margin was close to condylar process of mandible. No bony remodeling or erosion was seen. Medially lesion was displacing and compressing masseter. It has also resulted in mild anterior bowing of maxillary antral floor. Patient was sent to oral surgery department for incisional biopsy. Histopathology of incisional biopsy specimen revealed epithelial component consists of epithelial and myoepithelial cells with divergent growth patterns, including trabecular, tubular, solid, cystic and papillary architecture in a connective tissue background of myxoid in nature. A diagnosis of PA was given and excision of the whole mass was planned out. The case was taken under pre-anesthetic check-up. General anesthesia was given with nasotracheal tube using halothane and propofol. The incision was placed intraorally in the left vestibular region and was extended posteromedially using sharp and blunt dissection. The complete tumor was visualized and the surface of the tumor was firm in consistency. The complete tumor along with capsule was excised [Figures and ] and surgical site was irrigated with 10% betadiene mixed with normal saline in 1:1 ratio. Closure was done in layers keeping in mind the opening of stenson's duct. The excised tumor mass was sent for histopathological evaluation. On gross examination, the tumor mass measured 38 × 32 × 36 mm3 in size, with a whitish, faintly lobulated and focally glistening cut surface. The histopathological findings of the excised specimen were consistent with the incisional biopsy report [Figures –], confirming the diagnosis of PA. Post-operative healing was uneventful with maintenance of normal vestibular depth [].