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A huge parapharyngeal space tumor in a child.

A 3-year-old girl came to the Department of Pediatrics with fever and cough. Oral examination showed right oropharyngeal swelling, but there was no dysphagia, dysphonia, dyspnea, or easy choking noted. She was admitted to the pediatric ward, and magnetic resonance imaging (MRI) of her head and neck was arranged. The image showed a 4.7 x 4.3 x 3.7-[cm.sup.3] mass in the right parapharyngeal space, extending medially into the right pharyngeal mucosal space (figure 1).

We were consulted for evaluation of the tumor.

The oropharynx mucosa was smooth, and under nasopharyngoscopy, we noted narrowing of the oropharyngeal space. Transoral wide tumor excision with an oral mucosal flap reconstruction was performed smoothly. Tumor pathology revealed a desmoid-type fibromatosis (figure 2).

After the operation, the patient was admitted to the Pediatric Intensive Care Unit. Two days later, we removed the nasal endotracheal tube and transferred her to the general ward. She was discharged on the ninth day after the operation and had no swallowing, respiratory, or speech complications. Postoperative MRI of head and neck showed no narrowing of the oropharyngeal space (figure 3).

Parapharyngeal space tumors account for 0.5% of all head and neck masses, (1) and most clinicians will see only a small number of cases during their careers. In a 2014 review by Riffat et al, most of the tumors (82%) were benign and 18% were malignant; the most common primary lesions were salivary gland lesions (45%) and neurogenic lesions (41%). (2)

Surgical intervention is still the mainstay of treatment, and most masses are removed transcervically. (3) We use the transoral method for cosmetic reasons (to prevent scars on the neck). Sixty-seven percent of pediatric patients with primary parapharyngeal neoplasms have malignant tumors. (4) This strongly contrasts with adult tumors, with only some 20 to 30% of adult cases showing malignancy. Asa result, pediatric parapharyngeal space tumors need more careful evaluation and management.

References

(1.) Batsakis JG, Sneige N. Parapharyngeal and retropharyngeal space diseases. Ann Otol Rhinol Laryngol 1989;98(4 Pt 1):320-1.

(2.) Riffat F, Dwivedi RC, Palme C, et al. A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral Oncol 2014;50(5):421-30.

(3.) Cohen SM, Burkey BB, Netterville JL. Surgical management of parapharyngeal space masses. Head Neck 2005;27(8):669-75.

(4.) Starek I, Mihal V, Novak Z, et al. Pediatric tumors of the parapharyngeal space. Three case reports and a literature review. Int J Pediatr Otorhinolaryngol 2004;68(5):601-6.

Yuntsung Hung, MD; Chi-Shiun Huang, MD; Liang-You Yang, MD

From the Department of Otorhinolaryngology-Head and Neck Surgery (Dr. Hung and Dr. Huang) and the Department of Radiology (Dr. Yang), Changhua Christian Hospital, Changhua City, Taiwan.

Caption: Figure 1. This axial T1-weighted MRI of the head and neck shows a hyperintense mass located in the right parapharygeal space and anterolaterally into the masseteric space.

Caption: Figure 2. The specimen is a solid elastic mass with a smooth surface and measures approximately 6 x 4 x 3.2 cm.

Caption: Figure 3. Postoperative MRI of the head and neck shows a normal oropharyngeal space.

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Title Annotation:HEAD AND NECK CLINIC
Author:Hung, Yuntsung; Huang, Chi-Shiun; Yang, Liang-You
Publication:Ear, Nose and Throat Journal
Article Type:Report
Date:Apr 1, 2017
Words:518
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