Giant pediatric de novo parapharyngeal space pleomorphic adenoma: excision by semi trans-parotid cervical approach

BackgroundParapharyngeal Space tumors are rare tumors of the head and neck. They most commonly arise from the deep lobe of the parotid gland. Most of these tumors are in seen in adults and de novo origin from the minor salivary glands is extremely rare. The surgical approach needs to tailor made depending on the extent of the disease.Case presentationA female child presented with chief complaints of swelling below the left ear for 9 months. On examination, the swelling was firm and non-tender, measuring 6 x 4 cm. A smooth bulge was seen in the left oropharynx, pushing the uvula to the opposite side. Fine Needle Aspiration Cytology (FNAC) showed features of Pleomorphic Adenoma. Contrast-Enhanced Magnetic Resonance Imaging (MRI) revealed a 4 x 6.1 x 6.7 cm well-defined solid lesion in the left parapharyngeal space. It was isointense on T1 and hyperintense on T2. Surgical excision was done via semi trans-parotid cervical approach. The tumor was solid and seen separately from the parotid gland, suggestive of a de novo tumor diagnosed as pleomorphic adenoma on histopathology. The patient made a good recovery and is disease free at 1 year of follow-up.ConclusionSemi-transparotid combined with the cervical approach is a feasible option for large parapharyngeal space tumors without the need for mandibulotomy.