Tumors of the parapharyngeal space (PPS) are rare, accounting for less than 1% of all head and neck neoplasms, of which 70–80% are benign and 20–30% are malignant. The main treatment for this condition is surgical excision of the mass via a transcervical or transparotid-transcervical approach, or via a mandibilotomy in the case of large extensive tumors.
We report the case of a 57-year-old male with a very large PPS tumor, 102 × 85 × 80 mm in size, and with a 14-month history of breathing difficulty and dysphagia. The clinical manifestations included a mass in the oropharynx, a neck mass and Eustachian tube obstruction. Endoscopy showed a bulging, in the left parapharyngeal space, extending into the oropharynx, and causing a noticeable obstruction of the respiratory tract. The patient was operated on with a minimal invasive transcervical approach, and not via mandibulotomy, which was a challenging technique. This approach allowed us to avoid the complications and significant side effects such as infection, temporomandibular joint dysfunction, non-union of tissues, plate extrusion, and tooth loss that is often associated to mandibulotomy. Histological examination revealed a pleomorphic adenoma from a deep lobe of the parotid.
In conclusion, surgery is the mainstay of treatment for tumors of the parapharyngeal space. Here, we describe the removal of a large parapharyngeal pleomorphic adenoma transcervically with a minimally invasive approach without mandibulotomy.
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