Transcervical-transparotid skull base approach for giant deep lobe pleomorphic adenoma with parapharyngeal and retropharyngeal extension: avoidance of mandibulotomy through styloidectomy.
D P Caruso, A Bunnell, R P Fernandes
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Case in brief
A 33-year-old man had a giant pleomorphic adenoma involving both parotid lobes, with substantial parapharyngeal, retropharyngeal, and skull-base extension. The 8.4 × 7.1 × 4.0 cm tumor was removed en bloc through a transcervical-transparotid skull-base approach without mandibulotomy. Release of the stylomandibular ligament and complete styloidectomy widened the operative corridor and enabled anterior mandibular subluxation, facilitating medial and superior dissection without capsule violation. Total parotidectomy preserved all facial nerve branches. Transient marginal mandibular weakness resolved fully.
What made this case unusual
Despite the tumor’s size and skull-base extension, exposure was achieved without mandibulotomy by combining stylomandibular ligament release, complete styloidectomy, and anterior mandibular subluxation.
Diagnostic / clinical pearl
For extensive deep-lobe parotid tumors extending medially and superiorly, widening the stylomandibular corridor with ligament release and styloidectomy may provide access for dissection without mandibulotomy.