Department of ENT Fatima Jinnah Medical College/Sir Ganga Ram Hospital, Lahore

Parapharyngeal space is a potential space, which is divided by the styloid process into the prestyloid and poststyloid space. The primary parapharyngeal space tumours are rare and accounting for 0.5% of Head & Neck neoplasms. No doubt surgical removal of these tumours is challenging and access requires mandible split quite often. In this paper we review the brief anatomy, presentation and evaluation of four cases, which was operated in ENT and Head & Neck Surgery Department of Sir Ganga Ram Hospital and Manchester Royal Infirmary U.K. All these tumours have been removed without mandible split through Transcervical approach even with their enormous size.

Case No. l: Fifty two years female presented to the ENT OPD with a feeling of the sensation of fullness of the left side of the throat. She also complained of excessive salivation. There was no history of difficulty in swallowing or any systemic illness. Examination of the oropharynx revealed a swelling in the left parapharyngeal region with marked medial push of the left tonsil. The swelling was firm to hard in consistency with intact normal looking mucosa over it. No sign or symptom of any neurological deficit was noted. There was no regional lymphadenopathy. The laboratory data like CBC, ESR, Electrolytes, Blood Sugar and Urea was within the normal limit. FNAC result was Benign Salivary gland tumour. CT Scan shows a well defined rounded soft tissue density mass, measuring 3.1x 5.0 on, in the left parapharyngeal space. The mass was removed by upper cervical incision extending from the mastoid tip to the midline at the level of the hyoid bone. Submandibular gland was excised to gain access to the parapharyngeal space. Marginal mandibular nerve was identified and preserved. Facial vessels ligated and divided, Hypoglossal and Lingual nerves preserved, tumour was exposed deep to the ramus of the mandible and resected in toto with blunt dissection. She had uneventful recovery and was discharged after three days.

Article: Case Report

Keywords:

Pharynx.
Otorhinolaryngologic Surgical Procedures.
Pharyngeal Neoplasms.
Orthopedic Procedures.
Nasopharyngeal Neoplasms.
Pharyngeal Muscles.
Nasopharynx.
Tomography, X-Ray Computed.
Risk.

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