Pleomorphic adenoma of the parotid gland in parapharyngeal space: dumbbell tumor. A case report

We describe a case of a dumbbell tumor of the deep lobe of the parotid gland in prestyloid parapharyngeal space. The stylomandibular tunnel is rather narrow, so it creates an isthmus in the tumor, giving it the “dumbbell” shape described by Patey and Thackray. A 28-year-old man presented with a sensation of fullness in the right parotid region and right parotid swelling. An MRI, showed a dumbbell shaped tumor in the parapharyngeal space. There was a 6.50×3 cm expansive solid mass near the parotid tail. The preauricular skin incision with extension to the cervical region was sufficient to afford exposure for superficial parotidectomy and subsequently removal of a deep-lobe parotid tumor. Histopathological examination showed a neoplasm completely delimitated from a fibrous capsule and having an admixture of epithelial and stromal components consistent with pleomorphic adenoma. The dumbbell tumor of the parotid gland is a rare neoplasm of the head and neck. Surgical resection is the mainstay of therapy for these lesions. In this case a preauricolar approach was adequate to afford exposure for superficial parotidectomy and for removal of the deep-lobe parotid tumor, but a flexible approach should be planned to provide additional exposure as necessary with minimal associated morbidity and mortality.