PMC5907411_01
(a) Oral view of the palatal tumor. (b) Posterior nasal aperture view. Fiberscope was inserted from mouth and turned to posterior nasal aperture via uvula. Fiberscope tip was turned upside down, and posterior nasal aperture view was taken. Tumor can be seen in the left posterior nasal meatus area and is clearly invading the nasal septum. Right torus tubarius is intact.
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T4bN0M0 tumor had formed an ulcer in the palate and invaded the posterior portion of the inferior nasal turbinate. The pharyngeal orifice of the auditory tube was intact (Figure 1).
CT views. (a) Axial view: tumor invading the left posterior maxillary sinus but not the anterior area. (b) Coronal view: tumor invading the base of the pterygoid process. (c) Tumor not invading the orbital fossa or cranial bone. Red lines are dissection lines.
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Coronal view CT showed that the tumor had invaded the base of the pterygoid process without cranial base invasion (Figure 2(b)). The red lines in Figure 2 show the osteotomy lines.
Surgical procedure of the modified partial swing approach. (a) Weber-Fergusson incision was made, and an anterior maxillary flap was elevated. (b) Tumor was excised. (c) Reconstruction was performed with an ALT flap. (d) The maxilla flap was repositioned and fixed with miniplate.
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The resulting bone flap was then elevated (Figure 3(a)). After the flap was elevated, the tumor outline was visualized and the posterior sections of the maxilla and pterygoid process were resected (Figure 3(b)). Reconstruction was then performed using an anterior lateral thigh (ALT) flap (Figure 3(c)). The maxilla flap was repositioned and fixed with a miniplate (Figure 3(d)).
(a) Frontal view of model surgery. (b) Lateral view of model surgery. (c) Look-up view of model surgery. (d) View after tumor was resected, and the anterior maxilla flap was fixed with three miniplates.
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Mock surgery was performed on a 3D printer-generated model prior to the operation (Figure 4).
Frontal view two months after surgery.
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 Figure 5 shows a frontal view of the patient two months after surgery.