One-sided parapharyngeal Swelling – differential diagnosis

Purpose:

The differential diagnosis of parapharyngeal processes will be presented exemplary in the case of a 27-year-old patient with jaw clamp and increasing difficulty in swallowing.

Material and Methods:

Otolaryngologic, clinical examination. Standard laboratory testing. Imaging of the neck (CT scan). Planning of surgical treatment.

Results:

Clinical findings: Swelling and bulging of the soft palate on the left. Lack of uvula edema or mucosal redness. No tonsillar stains. No salivation. No fever. No halitosis. Mouth opening of maximal 2.5 cm.

CT scan of neck: Extensive infiltrate in the left lateral wall of the nasopharynx and oropharynx with marked protrusion into the pharyngeal lumen.

Laboratory results: Regular, with no increased inflammation parameters.

Pathology after transcervical excision of a tumor in the parapharyngeal space (5.8 × 4.4 × 3.4 cm in size): pleomorphic adenoma.

Conclusion:

In Patients with clinical evidence of a parapharyngeal process and missing signs of inflammation, the presence of a solid parapharyngeal tumor should always be considered. Imaging is recommended before taking a biopsy. Fine needle aspiration should be the preferred method of histological sampling. If a pleomorphic adenoma is suspected, open biopsies must be avoided in order to minimize the risk of recurrence due to tumor spilling.

Publication History

Publication Date:
23 April 2019 (online)