Parapharyngeal parotid pleomorphic adenoma: a case report

Introduction and importance: Parapharyngeal space (PPS) tumors are uncommon, accounting for 0.5%-1% of head and neck neoplasms. Diagnosis and treatment of parotid pleomorphic adenomas (PPA) extending to the PPS are difficult because the PPA is situated deep in the tissue. Case presentation: A 49-year-old woman presented with a sore throat, odynophagia, and foreign body sensation in the throat for 6 weeks. Physical examination revealed a bulge in the oropharynx. Imaging revealed a clearly demarcated lesion in the right PPS of the neck. PPA diagnosis was confirmed using fine-needle aspiration cytology. Surgical removal of the tumor was performed via a transcervical transparotid approach with preservation of the facial nerve. Histopathological examination confirmed the diagnosis of pleomorphic adenoma, and the patient's symptoms were alleviated, with no recurrence at 8 months of follow-up. Clinical discussion: The clinical onset is typically insidious and is characterized by a gradually enlarging mass in the parotid or upper neck, while oropharyngeal signs, such as dysphagia, snoring, dysphonia, or airway compromise, develop late in the course of the disease when the mass is sufficiently large or manifests as an intraoral bulge in the tonsillar or paratonsillar region. Conclusion: This case highlights the importance of meticulous diagnosis using radiography and tailored surgical treatment for PPA in PPS. The transcervical transparotid approach enables tumor removal while preserving facial nerve function.