Giant Lipoma of the Parapharyngeal Space: Surgical Considerations and Comprehensive Literature Review

The rarity of pharyngeal space lipomas (PPL) combined with the complex anatomy of the region makes both diagnosis and treatment challenging. We introduce the case of a patient with massive PPL with significant superior extension. Additionally, a review of the literature is presented with the aim of characterizing trends in presentation, diagnostic workup, and common surgical approaches to PPLs.

A 62-year-old male patient presented with a left-sided neck mass that had been progressively enlarging over several years. CT Soft Tissue Neck with contrast displayed a well-circumscribed mass measuring a maximum 10.6 cm in dimension in the posterior triangle of the neck, extending from the skull base within the parapharyngeal space to the supraclavicular fossa. The mass was subsequently excised through a transcervical surgical approach with facial nerve dissection, avoiding the need for mandibulotomy. Permanent section pathologic analysis was consistent with a simple lipoma. At the 1-month postoperative visit, the patient had recovered uneventfully with no evidence of cranial nerve deficits or dysphagia.

A literature search was conducted on PubMed for "parapharyngeal" + "lipoma". Since 1977, there have been 41 articles published on PPL with a total of 45 patients. A majority of patients are male (78%). The median maximum dimension of PPLs measured 7.2 cm, larger than other parapharyngeal space tumors. Currently, MRI and CT are the most commonly employed imaging modalities. Transcervical was the most popular surgical approach (n = 16, 36%), followed by transparotid (n = 7, 16%) and transoral (n = 5, 11%).

PPL management demands intricate preoperative planning, particularly when the mass extends into challenging anatomical territories. Advanced preoperative imaging, detailed understanding of anatomy, and a tailored surgical approach are key to management of tumors in the parapharyngeal space.