Large Pleomorphic Adenoma of the Submandibular Gland Causing Internal Jugular Vein Compression: Case Report
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SURGERY
Large Pleomorphic Adenoma of the Submandibular Gland Causing Internal Jugular Vein Compression: Case Report Atsushi Shudo 1,2 Accepted: 21 September 2020 # Springer Nature Switzerland AG 2020
Abstract Pleomorphic adenoma is the most common benign tumor of the major salivary glands. It is generally asymptomatic; however, it may adversely affect surrounding structures when it becomes enlarged. In the submandibular gland in particular, the cervical blood vessels may be compressed or displaced by the tumor, and surgery to remove the tumor is associated with a higher risk. The purpose of this report is to describe how an enlarged pleomorphic adenoma in the submandibular gland may compress or displace cervical blood vessels, demonstrating that 3-D computed tomography angiography could be valuable for preoperative evaluation. This article describes a rare case of a 46-year-old man who had an internal jugular vein compression as a result of leaving untreated a large pleomorphic adenoma in the submandibular gland. Considering the anatomical location, salivary gland tumors arising in the submandibular gland may adversely affect the surrounding structures such as the trachea or cervical blood vessels when they grow larger. Preoperative evaluation of the positional relationship between the tumor and the surrounding structures is essential. 3-D computed tomography angiography was valuable for preoperative evaluation of the positional relationship between the tumor and the surrounding blood vessels. By confirming the compressed and displaced blood vessels with 3-D computed tomography angiography, the skin incision line can be designed to allow for successful separation of the tumor. This report suggests that 3-D computed tomography angiography could ensure a safe surgical approach for removal of large benign submandibular gland tumors, including pleomorphic adenomas. Keywords Pleomorphic adenoma . Submandibular gland tumor . Internal jugular vein compression . 3D-CT angiography
Introduction Pleomorphic adenoma (PA), also known as a benign mixed tumor, is the most common benign salivary gland tumor. It is characterized by a slow-growing, wellcircumscribed, painless mass [1]. PAs arising from the
submandibular gland may affect the cervical blood vessels when enlarged. This article describes a rare case in a 46-year-old man who had an internal jugular vein compression as a result of nontreatment of a large PA in the submandibular gland.
This article title is part of the Topical Collection on Surgery
Case Presentation
* Atsushi Shudo [email protected]
A 46-year-old man was referred to the oral and maxillofacial department for further evaluation of a large submandibular mass. He had received inpatient treatment for severe diabetes mellitus (HbA1c: 9.9%) and spinal muscular atrophy (type 4) in our hospital. At the first clinical examination, a large mass was observed in his right neck, measuring about 10 cm in diameter (Fig. 1).
1
Department of Oral and Maxillofacial Surgery, Kishiwada Tokushukai Hospital,
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