My ENT has found a tumor on my soft palate. He called it a "pleomorphic adenoma" tumor. He says I need surgery. It would require partial removal of my soft palate, and I would need to be fitted with an obturator. Do they have any other methods of removal besides surgery? How does this obturator work?

M.D.

Pleomorphic adenoma is a benign salivary-gland tumor. "Benign," as you probably know, means "not malignant," which in turn means that this tumor will not spread to other parts of your body. It will, however, continue to enlarge if you do not have it removed. Pleomorphic adenomas can grow to enormous size. Fortunately, they tend to be slow-growing. But given enough time, this tumor will affect your speech, your ability to swallow, and (eventually) your ability to breathe. Thus, "no treatment" is a poor option.

Are there other options? One might try cryosurgery (freezing the mass with liquid nitrogen) for a very small pleomorphic adenoma. (On the other hand, if it were this small, your doctor could remove the mass without removing a portion of the soft palate, and you would not need an obturator, a device that substitutes for the missing part of the soft palate.) There is no chemotherapy (drug treatment) available for this tumor. Radiation therapy is theoretically possible, but it would be worse than needing an obturator. Radiation therapy to the oral cavity often results in lifelong problems with oral dryness and pain. The pain can be severe, even debilitating. Oral dryness promotes tooth decay and gingivitis. Finally, radiation therapy would put you at risk of developing oral cancers in the future.

A much better question is whether the tumor can be removed without the need for an obturator after surgery. This is something that you must ask your ear, nose and throat surgeon (ENT). You may even want to get a second opinion before proceeding with the operation. You should seek out an ENT who has done fellowship training in head-and-neck surgery (cancer surgery, in other words).

A digression on second opinions: Too often, people get their second opinion from "the other doc in town." In my opinion, if you are going to get a second opinion, the only thing that makes any sense is to head straight to a super-specialist. Some ENTs have done fellowship training -- one or two years of additional training AFTER their training in ENT -- and are thus better trained in the treatment options available for their particular subspecialty. In addition to head-and-neck cancer surgery, there are fellowships in allergy and sinus surgery, facial cosmetic and reconstructive surgery, otology (ears), laryngology (voice), and pediatric ENT problems. Many fellowship-trained super-specialists practice at medical schools, but a number of them are in private practice. The key question to ask is, "Are you fellowship-trained in ..."

Back to your questions: How does an obturator work? Your soft palate is important for both swallowing and speech. In both instances, the palate must be able to touch the back of the throat, closing off the nasal cavities. That's why, for example, you can swallow milk without the milk shooting out your nostrils. The soft palate "valves off" the nasal cavities to prevent this embarrassing occurrence.

An obturator looks a bit like a child's retainer, or a denture without teeth, only it is long enough to reach the back of your oral cavity. It may "fill the gap" left by surgery, and it will certainly support the remainder of your soft palate, in order to help it do its job. Even with an obturator, you may still have difficulties with speech and swallowing after the operation, and these may be permanent problems. Working with a licensed speech therapist can be very helpful in such cases, since speech therapists specialize in the rehabilitation not just of speech but also of swallowing problems.