Resection and Reconstruction of Maxillary Class IIIc Defect in a Case of Adenoid Cystic Carcinoma: Cost-Sensitive Technique without Microvascular Grafts

ACC is a rare malignant tumor that affects most commonly the major and minor salivary glands and rarely the paranasal sinuses, lacrimal gland, larynx, ear, vulva, and so forth. The maxillary sinus when affected is considered having a poor prognosis due to delayed diagnosis and delayed treatment credited to its slow spread, late symptoms, and complex anatomy which hampers surgical resection. The expressions of tumor markers too have a significant role in determining the prognosis. The treatment of choice consists of wide radical resection of the tumor followed by radiotherapy. Rehabilitation options in cases with huge maxillary defects still need further exploration. 1. Introduction Adenoid cystic carcinoma (ACC) is a rare malignancy, accounting for less than 5% of all head and neck cancers [1]. ACC arises within secretory glands, most commonly the major and minor salivary glands of the head and neck. ACC can also originate from sites other than the salivary glands, such as the lacrimal gland, external ear, paranasal sinuses, larynx, tracheobronchial tree, breast, and vulva, and such ACC is called nonsalivary ACC [2]. ACC of the maxillary antrum is frequently overlooked, and therefore, patients with this tumour usually come at an advanced stage making radical resection unlikely. Difficult access and anticipated surgical morbidity are other major barriers in treatment. Biological markers Ki-67, cyclineD1, E-cadherin, and p16 also have an important impact on prognosis [3, 4]. Older age, advanced stage, positive resection margin, high histological grade, and higher expression of Ki-67 were also associated with poor outcomes. 2. Case Report A 40-year-old male patient reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of painless swelling on the left side of the face and obstruction in nasal breathing since 3 years. The swelling was slow growing, painless, and persistent in growth. There was no reduction in size of the swelling since the patient had noticed it. Personal history was negative for any detrimental habits. On extra oral examination, a large swelling was seen on left side of face, extending superoinferiorly from medial canthus of left eye till left commissure of lips and anteroposteriorly from the left lateral surface of nasal septal cartilage till 4？cm short of tragus of left ear. On nasal examination, there was severe deviation of nasal septum seen towards the right side, along with thick polyp-like mucosal obstruction in the left nostril. On eye examination, the left eye was virtually closed and raised due to the