An Extremely Rare and Insidious Parapharyngeal Space Tumor

Introduction: Lipomatous lesions of the parapharyngeal space are rare. This is a case of a 64-year-old female with an extremely large lipomatous lesion infiltrating the left face, neck, and skull base. Methods: Detailed review of patient’s clinical, radiographic, and histopathologic records as well as literature review, suggesting this is only one of 12 such cases reported in English literature. Results: The patient was initially evaluated in the Laryngology clinic for progressive idiopathic subglottic stenosis, and a subtle fullness of the left side of the face prompted further evaluation. Imaging studies that were obtained in part to look at the subglottic stenosis revealed a very impressive mass lesion with the consistency of fat, diffusely involving the left parapharyngeal space, infratemporal fossa, and neck with compression and displacement of the great vessels. Management optons were discussed, and the treatment plan involved preauricular infratemporal approach for resection of tumor ( see full manuscript for specific details of biological behavior of tumor which guided intra-operative decision making ). Fortunately, final pathology was consistent with lipoma with no features of malignancy. Surgical morbidity included injury to sympathetic plexus leading to Horner’s syndrome and first-bite syndrome. The patient has had no signs of recurrence. Conclusions: Lipomatous lesions of the parapharyngeal base may present insidiously and are rare, as this is the only 12th reported case in English literature. Safe surgical resection of suspicious lesions can provide definitive diagnosis with minimal morbidity.