Giant Parapharyngeal Space Lipoma: Case Report and Surgical Approach

ABSTRACT

Large parapharyngeal space tumors near critical neurovascular structures pose challenging management problems. Only eight cases of a lipoma in the parapharyngeal space have been reported. We present a surgical approach that permits safe resection of such unusual tumors.

A 49-year-old man had a 2-year history of progressive pain in the left neck radiating from the shoulder to the occiput. Contrast-enhanced computed tomography (CT) of the neck demonstrated a fat-attenuation mass located in the poststyloid parapharyngeal space. The mass extended into the foramen transversarium at the level of the second cervical vertebra and encased the vertebral artery. The tumor was removed through an extended transcervical approach that included transection of the attachments of the sternocleidomastoid, trapezius, splenius capitus, and the longissimus capitus muscles. The approach provided access to the first cervical vertebra, allowing dissection of the tumor from the vertebral artery in the foramen transversarium. An extended transcervical approach provides exposure from the carotid artery to the vertebral artery and facilitates the complete excision of large parapharyngeal space masses.

KEYWORDS

Parapharyngeal space - lipoma - skull base surgery - vertebral artery

REFERENCES

• 1 Carrau R L, Myers E N, Johnson J T. Management of tumors arising in the parapharyngeal space.  Laryngoscope . 1990;  100 583-589
• 2 Carrau R L, Myers E N, Johnson J T. Management of tumors of the parapharyngeal space.  Oncology . 1997;  11 633-640
• 3 Elango S. Parapharyngeal space lipoma.  Ear Nose Throat J . 1995;  74 52-53
• 4 Abdullah B J, Liam C K, Mathew K M. Case Report: parapharyngeal space lipoma causing sleep apnea.  Br J Radiol . 1997;  70 1063-1065
• 5 Som P M, Biller H F, Lawson W. Parapharyngeal space masses: an update protocol based on 104 cases.  Radiology . 1988;  153 149-156
• 6 Hughes 3rd V K, Olsen K D, McCaffrey T V. Parapharyngeal space neoplasms.  Head Neck . 1995;  17 124-130
• 7 Pensak M L, Gluckman J L, Shumrick K A. Parapharyngeal space tumors: an algorithm for evaluation and management.  Laryngoscope . 1994;  104 1170-1173
• 8 Higashi K, Sarashina N, Okamoto T. Supernumerary ring marker chromosome as a secondary rearrangement in a parapharyngeal lipoma with t(10;12) (q25;q15) as the primary karyotypic abnormality.  Cancer Genetic Cytogenet . 1992;  64 163-165
• 9 Godwin W J, Chandler J R. Transoral excision of lateral parapharyngeal space tumors presenting intraorally.  Laryngoscope . 1988;  98 266-269
• 10 Krespi Y P, Sisson G A. Transmandibular exposure of the skull base.  Am J Surg . 1984;  148 534-538
• 11 Clayman G L, Adams G L. Modifications of the mandibular swing for preservation of occlusion and function.  Head Neck . 1991;  13 102-106
• 12 Sasaki C T, Sims S, Drago P, McNelis E. Surgical anatomy of the vertebral artery at the skull base.  Laryngoscope . 1992;  102 829-831