Giant De Novo Pleomorphic Adenoma Arising from the Parapharyngeal Space

Introduction. De novo pleomorphic adenomas in the parapharyngeal space are rare and cause difficulties in its surgical management. We report the largest de novo pleomorphic adenoma arising from the parapharyngeal space and discuss its surgical management. Presentation of Case. A 34-year-old male presented with a giant de novo pleomorphic adenoma arising from the parapharyngeal space, which was initially misdiagnosed as an impacted wisdom tooth. Measuring ？cm in size and weighing 87.3？g, this is the largest primary salivary gland tumour arising de novo from the parapharyngeal space reported in the literature, presenting challenges in its surgical management. Discussion. Parapharyngeal space tumours cause nonspecific symptoms and may be difficult to diagnose, which can allow the tumours to become very large and cause obstructive and compressive symptoms in an anatomically difficult area. A combined trans-cervical and trans-oral approach can be used to safely perform an en bloc resection. Conclusion. We report the diagnosis and surgical management of the largest pleomorphic adenoma arising de novo from the parapharyngeal space reported in the literature. 1. Introduction The parapharyngeal space is found anterior to the cervical column, posterior to the infratemporal fossa, and laterally to the nasopharynx. It forms an inverted pyramid with the skull base superiorly and the apex at the joint between the posterior belly of the digastric muscle and the greater cornu of the hyoid bone [1]. Tumours arising de novo in the parapharyngeal space are very rare and present challenges in achieving en bloc excision without spilling the contents of the tumour [1]. We describe the largest primary salivary gland tumour arising de novo from the parapharyngeal space and discuss its management. 2. Case History A 34-year-old male presented to our multidisciplinary head and neck clinic with a 3-year history of recurrent discomfort in his right retromolar trigone. These episodes were initially diagnosed by a dentist as an impacted wisdom tooth with subclinical infection and were treated with oral antibiotics with minor improvement in symptoms. One year prior to presentation, the patient noticed a prominence on the right side of his oropharynx but this was not reviewed by a medical professional. Over the last 2 years, the patient had worsening obstructive symptoms, including snoring, episodes of sleep apnoea, nasal speech, and a sensation of decreased hearing in his right ear. The patient also reported 7？kg of weight loss and lethargy in the preceding 3 months before