小唾液腺广泛分布于唇、腭、鼻腔、咽、喉的粘膜表面，因此可以起源于这些原发部位。口腔内小唾液腺肿瘤（IMSGT）虽然在普通人群中被认为罕见，但与所有其他口腔外部位相比却相对更为常见。正如索引患者中所见，多形性腺瘤是最常诊断的良性 IMSGT。口腔内小唾液腺肿瘤并不罕见，根据其大小、性质和位置，可能会导致患者呼吸、清晰说话和/或吞咽能力的严重限制，从而导致严重的发病率甚至死亡。除了这些有害影响之外，它们还给外科医生和麻醉师带来了重大的手术挑战，外科医生必须确定最安全、最可行的途径以确保完全或接近完全切除，麻醉师需要确保获得明确的结果。通过鼻子或嘴巴的气道，这两者都可能因肿瘤的存在而受到严重限制。目的是展示我们对文献中记录的最大的口腔内小唾液腺肿瘤之一的成功治疗，强调我们为解决我们面临的特殊手术和麻醉挑战而采取的具体措施。手术已经过去两年了，患者身体健康，生活质量显着改善，并且没有复发。患者为一名 50 岁男性，口腔顶部有一个缓慢生长的无痛性左腭肿块，病程已长达 10 年，并伴有反复自发性血性分泌物和打鼾。有吞咽困难和窒息的相关病史，左侧面部不对称，但没有脸颊肿胀、吞咽疼痛、喉咙痛或呼吸困难。就诊前大约两年，同侧上切牙缺失且牙齿无序。没有其他鼻科、耳科或眼科症状。无颈部肿胀、僵硬、咳嗽或胸部症状。由于口腔内肿块的大小，口咽体格检查受到很大限制。图 1. 面部不对称，左侧上颌骨隆起，左侧 1b 级和 2 个无压痛淋巴结肿大，可自由活动，不粘附于皮肤。颅面 CT 扫描显示广泛的等密度不均匀增强口腔内软组织肿块，占据整个腭/口腔，并横向侵犯咀嚼器和咽旁间隙，左上颌底和舌骨受到侵蚀。 图 2. 患者接受了切除术对有游离缘的腭部肿块进行活检。手术时无冰冻切片。组织学检查显示为多形性腺瘤，随访 2 年未发现复发迹象。预测者预计，延迟就诊会导致肿块增大，严重限制患者呼吸、清晰说话和/或吞咽能力，从而导致严重的发病率甚至死亡，但外科医生不会不知所措，熟练的麻醉师可能会在我们不进行气管切开术的情况下操纵鼻腔并获得手术的成功结果。版权所有 © 2024 西非医学杂志。

Minor salivary glands are widely distributed in the mucosal surface of the lips, palate, nasal cavity, pharynx, and larynx, thus can arise from any of these primary sites. Intra-oral minor salivary gland tumors (IMSGTs), while considered rare in the general population are relatively more common when compared to all the other extra-oral sites. Pleomorphic adenoma, as seen in the index patient, is the most commonly diagnosed benign IMSGT. Intra-oral minor salivary gland tumors are not uncommon and depending on their size, nature, and location can be associated with severe limitation of the Patient's ability to breathe, speak clearly, and/or swallow and consequent severe morbidity and even mortality. In addition to these deleterious effects, they present a major surgical challenge to the surgeon, who has to determine the safest, most feasible access to ensure complete, or near-complete excision, as well as to the anesthetist, who needs to secure a definitive airway through the nose or mouth, both of which could be significantly restricted by the presence of the tumor. The aim is to present our successful management of one of the largest intra-oral minor salivary gland tumors documented in the literature, highlighting the specific measures we undertook to tackle the peculiar surgical and anesthetic challenges we faced. It had been two years since surgery and the patient is thriving with a markedly improved quality of life and no features of recurrence. The patient is a 50-year-old male with a slowly growing painless, left palatal mass in the roof of the mouth of 10 years duration with recurrent spontaneous bloody discharge effluent and snoring. There was an associated history of dysphagia to solid with associated choking spells, a left-sided facial asymmetry with no cheek swelling, odynophagia, sore throat, or difficulty with breathing. There was ipsilateral loss of upper incisors and dental anarchy about two years before presentation. No other nasal, otologic, or ophthalmic symptoms were present. No neck swelling, stiffness, cough, or chest symptoms. The oropharyngeal physical examination was highly restricted due to the intra-oral size of the mass. Figure 1. There was facial asymmetry with a bulge of the left maxilla, left-sided levels 1b and 2 non-tender lymph node enlargements, freely mobile, not adhered to the skin. A craniofacial CT scan revealed extensive isodense heterogeneously enhancing intra-oral soft tissue mass occupying the entire palate/oral cavity and encroaching laterally on the masticator and the parapharyngeal space with erosion of the left maxillary floor and hyoid bone Figure 2. The patient had an excision biopsy of the palatal mass with a free margin. No frozen section at the time of surgery. Histology revealed Pleomorphic adenoma and was followed up for 2 years with no evidence of recurrence. Prognosticators are delay in presentation leading to an increase in size of the mass and severe limitation of the patient's ability to breathe, speak clearly, and/or swallow and consequent severe morbidity and even mortality, the surgeon not being overwhelmed, the skillful Anaesthesist that could maneuver the nasal cavity without us doing tracheostomy and the successful outcome of the surgery.Copyright © 2024 by West African Journal of Medicine.