Giant Parapharyngeal Space Pleomorphic Adenoma Causing Acute Airway Obstruction

Abstract

Primary parapharyngeal space (PPS) tumors are rare, representing only 0.5% of all head and neck neoplasms. About 80% of tumors of this space are benign, and 20% are malignant. They often pose therapeutic and diagnostic problems due to variable non-specific symptoms and the complex anatomy of this space. Pleomorphic adenoma is the most common benign tumor of this space. It presents as an asymptomatic mass causing mild bulging in the soft palate or tonsillar region, or fullness near the angle of the mandible in the neck. We report the case of a 60-year-old male admitted to the emergency department with breathing difficulty and acute stridor. He was unable to maintain oxygen saturation, and an emergency tracheostomy was performed. Radiological and cytological evaluation were performed, and the patient was diagnosed as having primary PPS pleomorphic adenoma. The tumor was excised via the transcervical approach. The rarity of tumor in this space and unusual life-threatening presentation prompted the authors to report this case. To our knowledge, this is the third case reported worldwide of a pleomorphic adenoma causing upper airway obstruction and acute respiratory failure.

Endoscopically assisted transoral resection of a Bailey type IV second branchial cleft cyst

“…When the tumor compresses the adjacent intracranial nerve and sympathetic trunk, then hoarseness, dysphagia or dyspnea, tinnitus and ear tightness, Horner sign, and soft palatal deviation caused by ipsilateral pharyngeal lateral wall compression can appear. [ 7 ] Further growth of the tumor can lead to invasion into the brain through the foramen ovale, anterior hypoglossal nerve tube, jugular foramen, and other structures. [ 8 – 10 ]…”

Molecular cytogenetic pilot study on pleomorphic adenomas of salivary glands

“…European-wide annual incidence of PAs is 4.2-4.9 per 100,000 inhabitants and year (2). PAs are slowly growing tumors which may remain asymptomatic and unrecognized over years, but they also can reach gigantic sizes and, if left untreated, are going together with dysphagia, dyspnea, great morbidity, or even malignant transformation (2,3). After parotidectomy, 2-3% of cases show local recurrences, while recurrence rates of up to 25-45% occurred after tumor enucleation (4).…”