A medically fit and well 13-year 11-month-old male was referred to the oral and maxillofacial surgery department at Alder Hey Children’s Hospital in Liverpool in regard to an intra-oral swelling of the right palatal region (Fig. 2). An incisional biopsy was initially reported as a pleomorphic adenoma of the premolar region. Subsequently, a CT scan showed no significant bony abnormality, and a wide local excision was carried out with the application of a surgical palatal dressing plate. Histopathology of this resected tissue appeared to show tumour of intermediate malignant grade at the base of the specimen.

Further investigations undertaken to stage the tumour included a repeat CT scan which presented no evidence of significant bony involvement or erosion. An MRI scan showed no significant asymmetry or signal abnormality in the region of the hard palate, and there was no evidence of loco-regional metastasis of this tumour.

Following a discussion of the craniofacial multidisciplinary team and numerous paediatric pathologists, a diagnosis of intermediate-grade sarcoma of the oral mucosa and hard palate was re-affirmed. A partial right-sided maxillectomy was planned to gain adequate tumour clearance, and prior to surgery, the patient attended for dental impressions and counselling regarding the procedures involved, together with instructions regarding the obturator prosthesis.

A low-level right-sided standard hemi-maxillectomy was carried out via an intra-oral approach with preservation of the pterygoid plates (December 2013). The anterior alveolar cut was undertaken through the right lateral incisor socket following the extraction of this tooth in order to maximise the bone support on the maxillary central incisor abutment tooth. The residual zygomatic body on the right side was exposed, and two 37-mm zygomatic oncology implants (Southern Implants Ltd, South Africa) (Fig. 3) were placed with excellent stability, ensuring that the prosthetic heads were positioned beneath the body of the obturator prosthesis and in a useful position for retention of the obturator. The posterior aspect of the cavity was dressed using the buccal pad of fat and the right inferior turbinate removed to facilitate access to the defect for the obturator. An interim prosthetic obturator was fitted and relined with silicone putty material and retained by dental clasps and a single bone screw into the midline of the remaining palatal bone. Recovery from the procedure was uneventful, and the patient was discharged home the following day. Histopathology confirmed the diagnosis of myxoid spindle cell carcinoma of the right maxilla excised with good margins with no need for adjuvant treatment.