Parapharyngeal space lipomatosis with secondary dyspnea, disphagia and disphonia

A Rare Cause of Dysphagia: Giant Lipoma in Parapharyngeal Space

BACKGROUND

Parapharyngeal area is one of the most complex areas of head and neck anatomy. Tumors of the parapharyngeal region are very rare among head and neck tumors. Lipomas also constitute a tiny proportion of parapharyngeal tumors so parapharyngeal area lipomas are very rare in the literature. Due to anatomical location, these tumors treatment is challenging.

CLINICAL REPORT

A 20-year-old male patient admitted to our department with complaints of swallowing difficulty and a mass on the right side of the neck. Magnetic resonance imaging was performed, and it was reported as a 6 × 4.5 cm lipoma. He underwent excision of parapharyngeal area lipoma by a transoral approach.

CONCLUSION

Parapharyngeal lipomas are very rare, and difficult to diagnose before they turn out symptomatic. The primary treatment approach in tumors of the parapharyngeal area is surgery and the surgical approach should be chosen according to the anatomical location of the lesion.

Endoscopically assisted transoral resection of a Bailey type IV second branchial cleft cyst: A case report

RATIONALE

The diagnosis of type IV branchial cleft cyst (BCC) according to the Bailey classification is very challenging due to lack of specific clinical manifestations in the early stage of the disease. Here, we present the transoral surgical route of endoscopic resection of second BCC in the parapharyngeal space (PPS) with good outcomes.

PATIENT CONCERNS

A 21-year-old man with a 1-year history of snoring complained about sore throat for 1 month and a fever that lasted for 3 days.

DIAGNOSES

On admission, physical examination revealed a temperature of 39°C, pain when swallowing accompanied with a lump sensation in the throat, and inability to open mouth more than 3 cm. Blood testing revealed 19.29 × 109 white blood cells (WBCs)/L and 14.94 × 109 neutrophils/L. A cervical computed tomography (CT) examination revealed a mass with liquid density of 6.2 × 4.0 × 7.7 cm3 in the left parapharyngeal space (PPS) and pharyngeal cavity stenosis. Postoperative pathology showed the existence of lymphoepithelial cysts (left PPS), which was in accordance with the diagnosis of BCC.

INTERVENTIONS

The patient was administered 1.5 g ceftazidime every 12 hours, anti-inflammatory drugs, and incision drainage was performed subsequently. Then, endoscopy-assisted resection of the left PPS was performed via the transoral route. We used low-temperature plasma and an 8-Fr Foley catheter with a water capsule during the surgery.

OUTCOMES

After resection of the mass, the patient's blood results returned to within the normal range and his symptoms improved. Five days postoperatively, the incision made in the palatine arch of the pharynx opened up by 1 cm, and eventually the wound and laceration healed. Normal oral eating was restored, and no complications were observed.

LESSONS

Magnetic resonance imaging (MRI), and color Doppler ultrasound can be useful to diagnose BCC in PPS, which rarely occurs in the clinical setting. Extended endoscopy provides a satisfactory surgical field for trans-oral resection allowing complete resection of the BCC without serious postoperative complications.