Recurrent Pleomorphic Adenoma Presenting as a Giant Parapharyngeal Mass

Introduction: Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, primarily found in the parotid gland. Recurrences often extend into the parapharyngeal space (PPS), complicating management. This report presents a case of a recurrent giant PA in the PPS following a limited excision. Case Description: A 45-year-old male presented with a gradually enlarging neck mass, dysphagia, and mild dyspnea, having previously undergone limited excision of a PA. Clinical examination revealed a firm mass in the right parotid region. Magnetic resonance imaging (MRI) showed a large mass in the right parapharyngeal space. Surgical excision was performed using a cervical-transparotid and mandibular swing approach. The patient was discharged after 7 days and later received radiotherapy. Discussion: Parapharyngeal space tumors (PPT) are rare neoplasms, with 70% to 80% being benign, primarily PAs. Symptoms include neck masses, swallowing difficulties, and potential cranial nerve involvement. MRI is crucial for assessing tumor extent. A combined transparotid-transcervical approach was employed. Postoperative radiotherapy was recommended. Conclusions: PPTs present significant clinical challenges, highlighting the need for meticulous surgical planning and complete excision of PAs to minimize recurrence risk. The close proximity of vital neurovascular structures requires careful preoperative evaluation and strategic surgical approaches.