An interesting case of parapharyngeal mass with retropharyngeal extension

Clinical details:

25 years old male came with c/o:

1. Fullness in the throat - 5 years

2. Difficulty in swallowing - 2 years

3. Breathlessness on and off accompanied by noisy breathing - 6 months

Past history:

Previous history of surgery in the neck ++ - 6 years back

Biopsy report from the mass excised during previous surgery - Swannnoma

On examination:

Swelling on the left side of the neck just below the angle of the mandible. It measured about 5 x 3 cms.
The skin over the swelling was not warm and was pincheable. The mass could be moved in its vertical axis.
Its mobility in the horizontal axis was somewhat restricted.

A linear scar could be seen over the neck mass measuring 6 cms. Previous skin incision.

Intraoral examination showed a large mass occupying the retropharyngeal wall crossing the midline.
This swelling could be seen pushing the left tonsil anteriorly and downwards. The upper border of the
Swelling could be seen just below the choana. The lower margin of the tumor could be seen reaching the
laryngeal inlet.

Videolaryngoscopic examination:

Imaging:

paramas_axial.JPG

Axial CT showing soft tissue mass involving parapharyngeal and retropharyngeal spaces

parapha_lat.JPG

CT scan head and neck lateral view showing soft tissue mass in the posterior pharyngeal wall

paraphy_AP.JPG

CT head and neck anteroposterior view showing soft tissue mass arising from parapharyngeal space extending medially partially occluding airway

Management:

Preliminary tracheostomy.

Ryles tube insertion.

Removal of mass via mandibular swing approach.

Video clipping of the surgical procedure:

mass_3.JPG
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