Management of parapharyngeal giant pleomorphic adenoma

Pleomorphic adenoma (PA) is found rarely in the parapharyngeal space (PPS). Because of late diagnosis due to slow growth, close proximity to vital neurovascular structures and risks of surgery, it poses a great difficulty for both diagnosis and surgical management. The preferred surgical approach to the PPS is the cervical-transparotid including a total parotidectomy with facial nerve preservation combined with a cervical access for dissection of cranial nerves and vascular structures thus allowing a safe removal of the tumor together with the parotid deep lobe. We report herein our experience in the management of giant PAs involving the prestyloid PPS and describe a not well-documented transparotid route by preservation of the parotid superficial lobe in combination with an intraoral approach.

In this retrospective study, three cases of patients having giant PAs involving the PPS are evaluated. All patients had signs of foreign body sensation in the throat and a growing mass bulging in the oropharynx. Diagnosis was based on MRI and upon preoperative intraoral biopsy. The average tumor size was 5.7 cm. Patients underwent surgery and excision of tumors via transparotid-intraoral approach. In two cases, the superficial lobe was preserved and afterwards put back in its anatomic location.

All patients were discharged without complications, and no recurrences were observed.

Preoperative diagnosis management of PPS giant tumors should be based on imaging and upon open transoral biopsy if possible. The transparotid-intraoral approach provided adequate visibility to remove large PAs involving the prestyloid PPS.