Diagnostic dilemma involving calcification in the parapharyngeal space - Metastatic thyroid carcinoma masquerading as a deep lobe parotid mass

As the parapharyngeal space is difficult to examine clinically the radiographic distinction between deep lobe parotid masses and extraparotid tumors is essential in determining the surgical approach. We describe the case of a 53-year-old woman who presented with facial pain consequent to metastatic papillary thyroid carcinoma of the parapharyngeal space. A highly unusual pattern of calcification was present in the mass as observed by panoramic radiography and computed tomography. Parapharyngeal metastasis as the presenting feature of occult thyroid carcinoma has only been described four times previously in the medical literature.