Neurilemmoma of the Parapharyngeal Space - Case Report

Abstract

The parapharyngeal space (PPS) is a potential space that extends from the skull base to the hyoid bone and is bounded medially by the fascia surrounding the pharyngeal constrictor muscle and laterally by the ramus of the mandible and the medial pterygoid muscle. PPS neoplasms comprise only 0.5% of all head and neck tumors, and neurogenic tumors such as neurilemmomas, schwannomas or paragangliomas constitute only 30% of these PPS tumors. We report the case of a 38-year-old woman who on presentation complained of a foreign body sensation when swallowing and was without neurological abnormalities. She was found to have a submucosal growth on the right side of the oropharyngeal wall. A tumor was found in the prestyloid compartment of the PPS with magnetic resonance imaging (MRI). A well-encapsulated tumor was surgically excised via a transcervical approach and proved to be a neurilemmoma. Postoperatively, paralysis of the right side of the tongue developed. Follow-up examinations have showed gradual recovery without disease recurrence over six months of follow-up Based on radiological classification of a PPS tumor as either prestyloid or poststyloid, the clinician can formulate the most appropriate management plan. MRI is valuable as a routine study for the differentiation of PPS tumors.