DESCRIPTION

Salivary gland tumours in children are rare (5%),1 but malignant tumours should not be overlooked in any differential diagnosis of palatal pigmented swellings. Mucoepidermoid carcinomas are the most frequent salivary gland tumour accounting for 50% of all malignant salivary gland tumours in children.2 In this case, a teenage Caucasian boy presented with an asymptomatic palatal blue swelling (fig 1).

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Figure 1

The lesion on initial presentation showing the bluish swelling in the hard palate.

A differential diagnosis for this lesion would include:

• Vascular lesions (haemangioma, varix, Kaposi’s sarcoma)

• Mucoceles

• Melanotic lesions (nevus, malignant melanoma)

• Lymphoma

• Salivary gland neoplasms.

A histological diagnosis of high-grade mucoepidermoid carcinoma was made, which resulted in the patient having a partial maxillectomy as it has the poorest prognosis (fig 2). He was referred by his dentist and the paedodontists to the oral and maxillofacial surgeons, as routine, which delayed diagnosis. This report highlights the importance of including minor salivary gland tumours in the differential diagnosis of palatal swellings in paediatric patients such that they can be referred urgently and an early diagnosis with appropriate intervention can be carried out. This will lead to prompt treatment while the lesion tumour is relatively small so as to optimise the survival rate.3

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Figure 2

The lesion at partial maxillectomy.