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Standard Operation Procedure Total Excision of Benign Tumor Pleomorphic Adenoma

Standard Operation Procedure Total Excision of Benign Tumor Pleomorphic Adenoma. 整理 : 連秀仁 94/06/20. General data. Name: 林王美雲 Chart No.: 1683726-6 Ward No.: B108–16 Sex: Female Birthday: 32/03/21 Date of admission: 93/11/15. Chief complaint.

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Standard Operation Procedure Total Excision of Benign Tumor Pleomorphic Adenoma

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  1. Standard Operation ProcedureTotal Excision of Benign TumorPleomorphic Adenoma 整理: 連秀仁 94/06/20

  2. General data • Name: 林王美雲 • Chart No.: 1683726-6 • Ward No.: B108–16 • Sex: Female • Birthday: 32/03/21 • Date of admission: 93/11/15

  3. Chief complaint • A painless mass over right soft palate for 1 month. Referred from I-Lan hospital.

  4. Present illness • This 61 y/o female is a case of pleomorphic adenoma. She has a history of brain tumor s/p OP, femoral fracture s/p OP, hyperlipidemia, & angina under medication control. About 1 month ago, she went to I-Lan hospital for dental examination, and mass over right palate was found. Then she was referred to our OPD for further evaluation. A 1x2cm painless ulcerative mass with induration & intact surface over right soft palate was noted. An incisional biopsy was made on 93/11/04, and pathological results was pleomorphic adenoma. Under the impression of pleomorphic tumor, she was admitted to our ward for total excision.

  5. Past medical history • Pleomophic adenoma over right soft palate • Left brain benign tumor s/p OP • Left femoral fracture s/p OP • Hyperlipidemia • Ischemic heart disease

  6. Lab data 93/11/15 • Electrolytes: CA: 8.8 mg/dl BUN: 11 mg/dl CREA: 0.9 mg/dl NA: 143 mmol/l K: 4.3 mmol/l CL: 107 mmol/l • CBC: WBC: 4100 /cumm L RBC: 3.43 m/cumm L HGB: 11.6 g/dl L HCT: 33.6 % L MCV: 98 fl H PLT: 183000 /cumm • DC: SEG: 62.8 % LYM: 27.1 % MONO: 6.5 % EOS: 2.6 % BASO: 1 %

  7. Operative procedure 93/11/16 • Under GA in supine position, patient was disinfected & drapped as usual. • The tumor was identified with 1 cm safe margin, total excised with electrosurgical knife, deepening to periosteum (17 was also removed) • Check bleeding • Remove irregular bone with rongeur & smoothen with bur • Irrigate with copious normal saline • The wound was covered by local flap obtained from soft palate nearby & buccal fat pad, sutured with 3-O vicryl • Surgical stent relined with tissue conditioner was fixed to palate with wire • Patient was sent to POR under stable condition

  8. Pathological report • Pathological diagnosis: Mixed tumor (Pleomorphic adenoma) • Gross finding: The specimen size is 4.3x3.2x1.5 cm. Focal ulceration of mucosa & well-defined gray tan firm submucosa mass (2.5x1.5x1.2 cm) are found. The mass is 0.2 cm from the nearest peripheral mucosal margin & the deep margin is not free.

  9. Post-OP • Post-OP antibiotic tx. • Pain control • Cold compression for 1 day (15min/hr) • Gargling & irrigation with chlorhexidine • Discharge under stable condition (93/11/22) • Arrange OPD F/U

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