Parapharyngeal growth of parotid tumors: report of two cases

Two patients with parapharyngeal pleomorphic adenomas of the parotid gland, one malignant and one benign lesion, were successfully treated operatively. Deep lobe parotid tumors may occasionally grow along the stylomandibular tunnel into the parapharyngeal region. Since the opening of the tunnel is narrower and less distensible than the parapharyngeal region, the tumor assumes a dumbbell shape. The patients have an intraoral mass or asymmetry of the palate, with difficulties in swallowing or phonation. The diagnosis is suspected on bimanual examination, and puncture biopsies should be done to establish a histologic diagnosis. Operative removal of the parotid gland with facial nerve preservation is recommended. External, transoral, and combined approaches can be employed. Enlargement of the opening of the stylomandibular tunnel by cutting the styloid process of the mandible is necessary for complete tumor removal. Rupture of the capsule should be avoided. Results are rewarding with proper management.