ABSTRACT Deep-lobe pleomorphic adenoma of the parotid gland with parapharyngeal space extension is uncommon and can be surgically demanding despite benign histology. We report a 36-year-old woman with a 2-year history of right parotid swelling. Magnetic resonance imaging showed a large multilobulated deep-lobe parotid mass extending into the parapharyngeal space, with contralateral airway deviation, internal jugular vein compression, and close contact with the carotid axis. After multidisciplinary discussion, catheter angiography demonstrated arterial supply from the internal maxillary artery and terminal branches of the external carotid artery. Selective preoperative embolization with polyvinyl alcohol particles, 300–500 μm, was performed 2 days before surgery. Tumor resection was undertaken through a transmandibular approach using a cervico-parotid incision with upper-neck extension, lower lip-chin split, and midline mandibulotomy, with early carotid control, ipsilateral submandibular gland removal, and facial nerve preservation. Complete excision was achieved in approximately 3 h, with an estimated blood loss of 200 mL and no transfusion. Histopathology confirmed pleomorphic adenoma with epithelial and myoepithelial elements in a myxoid stroma, duct-like structures, and focal squamous metaplasia, without malignant cytologic features. At 3 months, mild early Frey syndrome was noted, but swallowing, breathing, occlusion, and mandibular function were preserved. The fixation plate was removed uneventfully at 6 months, and 9-month photographs documented satisfactory facial contour and preserved dynamic facial movement.
Đặng et al. (Fri,) studied this question.