Giant, Deep Parotid Lobe Tumor: A Challenging Surgical Case

• Published in: Skull Base Vol. 19; no. S 02
• Main Authors: Kochilas, X., Primetis, E., Gargas, D., Crowther, J.
• Format: Conference Proceeding Journal Article
• Language: English
• Published: 04.06.2009
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2009-1224491

Background and Aim: Parotid tumors are relatively frequent, representing approximately 2% of all tumors in the neck area. The pleomorphic adenoma is usually found in the superficial lobe of the parotid gland, whereas deep lobe involvement is relatively rare. However, such tumors involving the deep parotid lobe may present with a neck mass that may have an intraoral extension (sometimes a dumb-bell mass). The surgical approach depends on size and location of the tumor and may be transoral, cervical, transmandibular, transparotid, retromandibular approach, or a combination. Case Report: A 30-year-old woman came to the ENT outpatient clinic with swallowing difficulties, weight loss, and the sensation of a foreign body in her nasopharynx. Clinical examination revealed a large, smooth, painless, and firm mass that was occupying the nasopharynx and extending to the oropharynx, which was, in part, occluded. The anatomy of the area was totally distracted. The patient had no other symptoms. Both CT and MRI scans showed a mass of 7 × 6 × 6 cm occupying the right parapharyngeal space with the most probable origin being the right parotid gland. A fine-needle aspiration biopsy confirmed the suspicion of a pleomorphic adenoma. A total parotidectomy was performed with identification and preservation of the neural structures of the area. The patient was discharged after a couple of days, without any complications. The histology report showed a pleomorphic adenoma as well. At the first year follow-up, there was no recurrence or other complication. Conclusion: An exhaustive diagnostic and management algorithm is required in this kind of lesion. Computer tomography and fine-needle aspiration biopsy are, in our opinion, mandatory to avoid histological surprises. The surgical approach should be individualized to provide excellent visibility with wide surgical exposure and to avoid neurovascular complications.