A challenging case of right sided parapharyngeal cystic schwannoma: a case report

Abstract

The parapharyngeal space (PPS) is a potential deep space of the neck located lateral to the upper pharynx. The clinical concerns are usually due to encroachment of tumors originating from adjacent structures such as salivary glands. These tumors are considered rare entities in the available literature in otolaryngology, so we appreciate this case and would like to present it to interested readers. A 73-year-old male patient reported swelling in the right side of the neck with difficulty swallowing, choking, change of voice, and right-sided ear pain for 9 months. Clinical examination revealed a well-defined solitary oval mass of more than 6×4 cm below the right angle of the mandible just anterior to the upper part of the right Sternocleidomastoid muscle encroaching the lumen of the oropharynx behind the right posterior tonsillar pillar, displacing the right tonsil and the parapharyngeal wall forward and medially with obvious extension to the nasopharynx and hypopharynx with normal and healthy overlying mucosa. The right side of the soft palate was pushed downward and the uvula was also displaced severely downward and to the opposite side. It was soft and cystic on palpation. A CT scan of the neck was requested which revealed a cystic mass in the right PPS. Surgical excision of the cyst by external transcervical route under general anaesthesia. Histopathological examination features are consistent with Schwannoma.