Conservative Lateral Approach for Pleomorphic Adenomas of Parotid Gland Involving the Parapharyngeal Space—A Case Series

Indian Journal of Otolaryngology and Head & Neck Surgery (2021)Cite this article

Abstract

The aim of this paper is to present and discuss the symptoms, clinical signs, diagnostic methods and a conservative surgical approach to large parotid pleomorphic adenomas arising from deep lobe and extending to the parapharyngeal space. In this case series we are describing four such cases which presented with painless swelling of different sizes in the parotid region along with intraoral swelling. Detailed diagnostic workup which included computed tomography scan, fine needle aspiration biopsy and magnetic resonance imaging was undretaken for confirming the diagnosis. Complete excision of the tumour via transcervical and transparotid approach without mandibulotomy and after securing local neurovascular structures was performed in all cases. This conservative lateral approach reduces the likelihood of complications. All the four patients were discharged without any complications and a proper follow up was done.

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References

  1. 1.

    Bozza F, Vigili MG, Ruscito P, Marzetti A, Marzetti F (2009) Surgical management of parapharyngeal space tumours: -year follow-up. Acta Otorhinolaryngol Ital 29:10–15

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Batsakis JG, Sneige N (1989) Parapharyngeal and retropharyngeal space diseases. Ann Otol Rhinol Laryngol 98:320–321

    CAS  Article  Google Scholar 

  3. 3.

    Rodriguez-Giurana J, Rodado C, Saez M, Bassas C (2000) Giant parotid pleomorphic adenoma involving the parapharyngeal space: report of a case. J Oral Maxillofac Surg 58:1184–11872

    Article  Google Scholar 

  4. 4.

    Miller FR, Wanamaker JR, Lavertu P, Wood BG (1988) Magnetic resonance imaging and the management of parapharyngeal space tumours. Head Neck 18:67–77

    Article  Google Scholar 

  5. 5.

    Barnes L, Eveson JW, Reichart P et al (eds) (2005) Pathology and genetics of head and neck tumours. IARC Press, Lyon

    Google Scholar 

  6. 6.

    Yousem DM, Sack MJ, Scanlan KA (1994) Biopsy of parapharyngeal space lesions. Radiology 193:619–622

    CAS  Article  Google Scholar 

  7. 7.

    Olsen KD (1994) Tumors and surgery of the parapharyngeal space. Laryngoscope 104(Suppl 63):S1–S28

    Article  Google Scholar 

  8. 8.

    Khaf A, Segev Y, Kaplan DM, Gil Y, Fliss DM (2005) Surgical management of parapharyngeal space tumors-a 10 year review. Otolaryngol Head Neck Surg 132:401–406

    Article  Google Scholar 

  9. 9.

    Basaran B, Polat B, Unsaler S, Ulusan M, Aslan I, Hafiz G (2014) Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases. Acta Otorhinolaryngol Ital 34:310–316

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Dimitrijevic MV, Jesic SD, Mikic AA, Arsovic NA, Tomanovic NR (2010) Parapharyngeal space tumors: 61 case reviews. Int J Oral Maxillofac Surg 39:983–989

    CAS  Article  Google Scholar 

  11. 11.

    Kuet ML, Kasbekar AV, Masterson L, Jani P (2015) Management of tumors arising from the parapharyngeal space: a systematic review of 1,293 cases reported over 25 years. Laryngoscope 125:1372–1381

    Article  Google Scholar 

  12. 12.

    Papadogeorgakis N, Petsinis V, Goutzanis L, Kostakis G, Alexandridis C (2010) Parapharyngeal space tumors: surgical approaches in a series of 13 cases. Int J Oral Maxillofacial Surg 39:243–250

    CAS  Article  Google Scholar 

  13. 13.

    Bass RM (1982) Approaches to the diagnosis and treatment of tumors of the parapharyngeal space. Head Neck Surg 4:281–289

    CAS  Article  Google Scholar 

  14. 14.

    Zhi K, Ren W, Zhou H, Wen Y, Zhang Y (2009) Management of parapharyngeal-space tumors. J Oral Maxillofac Surg 67:1239–1244

    Article  Google Scholar 

  15. 15.

    Avitia S, Hamilton JS, Osborne RF (2007) Deep-lobe parotid tumor presenting in the parapharyngeal space. Ear Nose Throat J 86:730–731

    Article  Google Scholar 

  16. 16.

    Hussain A, Murray DP (2005) Preservation of the superficial lobe for deep-lobe parotid tumors: a better aesthetic outcome. Ear Nose Throat J 84:518–524

    Article  Google Scholar 

  17. 17.

    Sergi B, Limongelli A, Scarano E, Fetoni AR, Paludetti G (2008) Giant deep lobe parotid gland pleomorphic adenoma involving the parapharyngeal space. Report of three cases and review of the diagnostic and therapeutic approaches. Acta Otorhinolaryngol Ital 28:261–265

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Ehrlich H (1950) Mixed tumours of the pterygomaxillary space; operative removal; oral approach. Oral Surg Oral Med Oral Pathol 3:1366–1371. https://doi.org/10.1016/0030-4220(50)90297-0

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Tryggvason G, Barnett A, Kim J, Soken H, Maley J, Hansen MR (2012) Radiographic association of schwannomas with sensory ganglia. Otol Neurotol 33:1276–1282

    Article  Google Scholar 

  20. 20.

    Carrau RL, Myers EN, Johnson JT (1990) Management of tumors arising in the parapharyngeal space. Laryngoscope 100:583–589

    CAS  Article  Google Scholar 

  21. 21.

    Khafif A, Segev Y, Kaplan DM, Gil Z, Fliss DM (2005) Surgical management of parapharyngeal space tumors: a 10-year review. Otolaryngol Head Neck Surg 132:1–406

    Article  Google Scholar 

  22. 22.

    Dimitrijevic MV, Jesic SD, Mikic AA, Arsovic NA, Tomanovic NR (2010) Parapharyngeal space tumors: 61 case reviews. Int J Oral Maxillofac Surg 39:983–989

    CAS  Article  Google Scholar 

  23. 23.

    Goodwin WJ Jr, Chandler JR (1988) Transoral excision of lateral parapharyngeal space tumors presenting intraorally. Laryngoscope 98:266–269

    PubMed  Google Scholar 

  24. 24.

    Shahab R, Heliwell T, Jones AS (2005) How we do it: a series of 114 primary pharyngeal space neoplasms. Clin Otolaryngol 30:364–367

    CAS  Article  Google Scholar 

  25. 25.

    Kolokythas A, Eisele DW, El-Sayed I, Schmidt BL (2009) Mandibular osteotomies for access to select parapharyngeal space neoplasms. Head Neck 31:102–110

    Article  Google Scholar 

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  1. ENT Department SKIMS Medical College and Hospital, Srinagar, Kashmir, India

    Asef Ahmad Wani, Raphella Khan, Ayaz Rehman & Masood H. Kirmani

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  1. Asef Ahmad Wani
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  2. Raphella Khan
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  3. Ayaz Rehman
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  4. Masood H. Kirmani
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Correspondence to Asef Ahmad Wani.

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Wani, A.A., Khan, R., Rehman, A. et al. Conservative Lateral Approach for Pleomorphic Adenomas of Parotid Gland Involving the Parapharyngeal Space—A Case Series. Indian J Otolaryngol Head Neck Surg (2021). https://doi.org/10.1007/s12070-021-02409-y

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Keywords

  • Pleomorphic adenoma
  • Parapharyngeal space extension
  • Conservative lateral approach