Transcervical Approach for Parapharyngeal Tumor Arising from the Deep Lobe of Parotid Gland: Case Report
Journal
Balkan ORL-HNS
Date Issued
2025-01-31
Author(s)
Kamshikoski, Igor
Methodius University, Skopje, Republic of Macedonia
Trajkovska-Jovchevska, A
Todorovska Stojanov Hristina
Saints Cyril and Methodius University of Skopje
Karadjinova Angelovska Nina
Hospital Universitario Clinico San Cecilio, PZU Polyclinic Akus Medikus, Saints Cyril and Methodius University of Skopje, University of Parma, Universitätsklinikum Gießen und Marburg
DOI
10.5152/bohns.2025.24047
Abstract
Tumors of the parapharyngeal space (PPS) are rare, constituting 0.5%-1% of head and neck masses, with most being benign and originating from salivary glands. The PPS, an anatomically complex region, is divided into prestyloid and poststyloid compartments. Management of these tumors is challenging due to their location and potential impact on surrounding neurovascular structures. We report a 75-year-old female patient pre-senting with dysphagia, transient apnea, and mild conductive hearing loss. Examination revealed a submucosal mass on the left lateral oropharyngeal wall, displacing the soft palate and anterior tonsillar pillar. Magnetic resonance imaging (MRI) identified a 30 !55 ! 62 mm mass arising from the deep lobe of the left parotid gland, confirmed as a pleomorphic adenoma by core biopsy. A transcervical approach was utilized for tumor resection. The procedure involved a transverse incision below the mandible, with care-ful identification and preservation of the carotid artery, internal jugular vein, and cranial nerves. The tumor was excised in total by dissecting around its capsule, ensuring minimal disruption to surrounding structures. Parapharyngeal space tumors present significant surgical challenges due to their anatomical complexity and proximity to critical struc-tures. Magnetic resonance imaging provides essential preoperative information, guid-ing the surgical approach. The transcervical approach offers direct access to the inferior PPS, facilitating safe tumor removal and preservation of neurovascular integrity. This case underscores the importance of selecting an appropriate surgical technique based on tumor characteristics and location, with the transcervical approach being a reliable and safe technique.