Right Hemi Maxillectomy Indicated for an Adenoid Cyst Carcinoma of the Palate with Intra Sinus Extension Operated on at the University Clinics of Kinshasa/DRC, Department of Oral and Maxillofacial Surgery

Introduction: Cystic adenoid carcinomas, formerly known as cylindromas, are malignant epithelial tumours of the accessory salivary glands. They are generally slow-growing tumours that generally affect the 40 to 60 age group, without gender preponderance, and their preferred site is the hard palate. The risk factor is not well known. Dental surgeons receive very little training in this diagnosis, which means that it is often made very late and the extent of the lesions is considerable.Observations: Patient aged 65, transferred from a hospital in the provincial city of Kinshasa to the University Clinics of Kinshasa, Department of Oral and Maxillofacial Surgery for a documented cystic adenoid carcinoma of the palate. The functional signs were dysphagia, dysphonia and dyspnoea. The exo-oral examination was marked by a deformity of the right hemi-face that was painful to palpation, right nasal obstruction, right palpebral oedema, loss of sensitivity of the right hemi-face, and clinical absence of adenopathy. The endobuccal examination revealed a fleshy, budding mass approximately 5*3 cm in diameter occupying the hard palate and extending to the soft palate. Surgery consisted of a right hemi-maxillectomy plus a maxillofacial obturator prosthesis.Discussion: The presentation of this clinical case is particularly linked to the slow, insidious, painless course of the disease, but also to the particular way in which adenoid cystic carcinoma extends to the palate. The lack of early diagnosis by dentists explains the frequent delay in diagnosis. Initial T4 stages account for more than 75% of cases, as was the case in our presentation, but lymph node metastases and distant metastases are also rare at the time of diagnosis, and in fact we did not find any satellite lymph nodes. Treatment consisted of surgery (hemi-maxillectomy) plus fitting of a maxillofacial obturator prosthesis. Conclusion: This case shows that a delay in consultation, misdiagnosis, neglect or poor management of adenoid cystic carcinoma can be at the root of progression to a more advanced stage of the disease, which may also require more complex and difficult management, especially in a context of poverty such as ours.