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Deep Lobe Parotid Tumors

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Deep Lobe Parotid Tumors

Deep lobe parotid tumors which are located deep to the facial nerve are rare. If you have a deep lobe tumor make sure your surgeon has extensive experience treating these tumors. The “deep lobe” of the parotid gland makes up a variable amount of salivary gland tissue lying deep to the facial nerve. Approximately 10% of parotid tumors arise from the “deep lobe”, with a small proportion of these developing extensions around the jaw bone and into the deep spaces of the neck lying adjacent to the pharynx or throat. When deep lobe tumors extend beyond the confines of the parotid capsule, they encroach on other important neck structures beyond the facial nerve. These important structures may include the carotid artery, jugular vein, lingual nerve, vagus nerve, and glossopharyngeal nerve. Because of the complexity of structures in and around the space occupied by the tumor, these cases present a greater surgical challenge. Dr. Osborne has extensive experience treating superficial and deep lobe parotid tumors. Diagnosis of deep lobe tumors may be elusive because of their hidden location.

Deep-lobe parotid tumor presenting in the parapharyngeal space

by Sofia Avitia, MD, Jason S. Hamilton, MD, and Ryan F. Osborne, MD, FACS

A 31-year-old man presented with an oral mass that had become progressively larger over the previous several months. He denied any odynophagia, dysphagia, otalgia, weight loss, or respiratory distress. On intraoral examination, the patient was noted to have a left-sided submucosal mass that involved the left oropharynx (figure 1). On nasal endoscopy, submucosal fullness was seen in the left nasopharynx; on laryngoscopy, the left oropharyngeal fullness was seen extending to the hypopharynx. However, the true vocal folds were mobile bilaterally, and the airway remained patent. Magnetic resonance imaging (MRI) of the neck revealed a left-sided 6.8-cm parapharyngeal space (PPS) mass (figure 2). No fat tissue plane was seen between the deep lobe of the left parotid gland and the mass. Radiographically, this finding was consistent with the presence of a deep-lobe parotid tumor.

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