Double mandibular osteotomy with coronoidectomy for tumours in the parapharyngeal space

Parapharyngeal Lipoma Extending to Skull Base: A Case Report with Surgical Approaches

Parapharyngeal lipoma with skull base extension is rare tumor found in head and neck region. We report a case of 66 years old female patient with left side face swelling extending to neck. On clinical examination, it was found soft, non-tender, mobile swelling present over left side pre-auricular region. It was extending from pretragal area superiorly to left submandibular region inferiorly. CECT neck and fine needle aspiration cytology was done to know the benign nature of disease. It suggest tumor extending from skull base to C6 vertebral level in parapharyngeal space. Tumor was excised via Trans parotid-transcervical approach. Parapharyngeal lipomas are confined to either the prestyloid or post styloid compartments. We report an unusual parapharyngeal lipoma involving both the compartments of the parapharyngeal space.

Management of a rare case of parapharyngeal lipoma presentation of case

INTRODUCTION AND IMPORTANCE

Parapharyngeal masses are rare but critical because of their deep location and their important anatomical relationships with the surrounding structures. Their management poses a challenge in terms of etiological diagnosis and adequate therapeutic approach. The clinical and especially the radiological examination have an important role not only for the diagnosis but also for the determination of the appropriate management and for the orientation towards the nature of the mass.

CASE PRESENTATION

We present the case of a 44-year-old man with a parapharyngeal lipoma that caused mainly obstructive sleep apnea syndrome. Once in our structure after a radiological examination (MRI and CT scan), a decision for surgical management was made. Surgery consisted on a combined cervical and endobuccal approach. The follow-up showed an effective result with the total resolution of the discomfort caused by the mass, which improved the patient's quality of life.

CLINICAL DISCUSSION

Tumors in this space represent less than 1 % of all head and neck tumors and are usually benign. Symptoms leading the patient to consult a doctor only appear after a significant volume of the mass, which makes the severity of this pathology. Imaging, namely CT and MRI, should be requested systematically in case of suspicion of any parapharyngeal mass. Several surgical approaches are described in the literature, the choice between them depends on the nature of the mass, its location and especially its extension, hence the interest of preoperative imaging.

CONCLUSION

The main take-away lessons are the great value of imaging in the diagnosis and treatment of parapharyngeal space masses, the relationships of this region and its content make the surgery very delicate, so it's so important to choose the appropriate surgical approach.

[Lateral transmandibular route for deep-lobe parotid tumor excision]

The parapharyngeal space may be a site for tumors, especially for those developed in the deep parotid lobe. The surgical route to parapharyngeal space tumors is a challenge because of neighbor anatomic structures and the specific risk of mandibular nerve damage. The aim of this study was to describe an original lateral transmandibular route, setting aside the mandible angle and preserving the mandibular nerve.

Transmandibular approach to polycentric recurrent pleomorphic adenoma of the parapharyngeal space

Surgery for tumors of the parapharyngeal space PPS) requires adequate exposure to identify and protect vital structures. Thus transcervical and transcervical-transparotid approaches to the PPS may be enhanced by mandibulotomy for better visualisation. We have chosen this approach with single mandibulotomy just in front of foramen mentale and without lip incision. We present a 39 years old male who was undergone surgery for policentric recurrency of a pleomorphic adenoma of the parapharyngeal space.