Parapharyngeal schwannoma treated by rhytidectomy approach

Parapharyngeal neoplasms are rare (0.5% of all head and neck tumours) and about 17%-30% of them are neurogenic tumors. Neurilemmoma (or benign schwannoma) is the most common parapharyngeal neurogenic tumor. We are proposing an aesthetic surgical approach. A 61-year-old woman presented with painless swelling of the parotid region. We performed lateral parotidectomy through rhytidectomy incision. We excised an encapsulated, 4,3 x 2,2 x 1,8 cm-sized neurilemmoma, involving the post-styloid compartment of the parapharyngeal space. Post-operative transient monolateral inferior lip palsy occured. After 2-year follow up, aesthetic results were satisfactory. The mainstay of PPS tumors treatment is surgical excision. Transoral, transcervical, transparotid, mandibulotomy, infratemporal, transcervical-transmastoid approaches and their combinations have been proposed: their advantages, disavantages and indications are being discussed and the literature is being overviewed.