Mucoepidermoid Carcinoma of the Hard Palate: A Case Illustrating Grading Uncertainty and Bone-Sparing Surgical Management.

Mucoepidermoid carcinoma (MEC) of the hard palate presents diagnostic and surgical challenges, particularly regarding histological grading and preservation of the underlying palatal bone. Histological grading remains controversial because of multiple grading systems and inter-observer variability. A 42-year-old man presented with a painless 10-12 mm right paramedian hard-palate swelling that had been present for approximately 12 months, with slight enlargement over the preceding two months, identified incidentally during routine dental examination. Biopsy confirmed MEC. MRI and CT demonstrated a 15 × 12 × 5 mm lesion with cortical thinning but no cortical breach or definitive bone invasion. Following multidisciplinary team discussion, wide local excision with periosteal elevation and preservation of palatal bone was performed because of the small, well-circumscribed lesion, low-risk histological features, absence of radiological or intra-operative bone invasion, and importance of preserving palatal function. Final histology demonstrated low-grade features by AFIP criteria and intermediate-grade features by the Brandwein system, with no bone invasion. This case illustrates the challenges of grading discordance and integrating histopathological, radiological and intra-operative findings when considering bone-sparing surgery. In selected low-risk palatal MECs without evidence of osseous invasion, conservative surgery may provide good short-term functional outcomes. Multidisciplinary interpretation of grading, imaging and intra-operative findings may support bone-sparing management in carefully selected palatal MEC.