Transparotid and transcervical approaches for removal of deep lobe parotid gland and parapharyngeal space tumors

Deep lobe parotid gland and ectopic minor salivary gland tumors are the most common primary lesions found in the parapharyngeal space. Most deep lobe parotid tumors are pleomorphic adenomas; they are usually contained within the parotid gland space but may expand into the prestyloid parapharyngeal space compartment. A transparotid approach is the preferred surgical method of extirpation of deep parotid lobe tumors, though it involves dissecting and transposing branches of the facial nerve to gain adequate access. In most cases of ectopic minor salivary gland tumors contained within the prestyloid parapharyngeal space, a transcervical approach is safe and offers excellent direct visualization of the tumor and all critical neurovascular structures. For large tumors involving the deep parotid lobe and extending into the prestyloid parapharyngeal space, a combined transparotid-transcervical approach is usually warranted, both to gain adequate access and to perform the surgery safely with limited morbidity.