Background. Middle-ear carcinoid tumour is a rare malignant tumour with an indolent course occasionally causing regional or distant metastasis. This paper presents a case of middle-ear carcinoid tumour metastasising to the parapharyngeal space and the parotid gland 20 years after the first surgery.

Case report. A 35-year-old woman who underwent multiple tympanomastoidectomies for middle-ear carcinoid presented with tumours of both the parapharyngeal space and parotid gland, detected by regular imaging. Based on the clinical course, metastatic relapse of middle-ear carcinoid was suspected. This was treated with subtotal parotidectomy with elective neck dissection (levels II and III), leading to the pathological diagnosis of carcinoid tumour. A cervico-parotid approach was selected to avoid complications associated with parapharyngeal space tumour removal. Transient facial palsy (House–Brackmann grade III) occurred, which completely recovered two months after surgery.

Conclusion. Awareness of parapharyngeal space tumours possibly caused by metastasis from a middle-ear tumour is necessary.

Many approaches to the parapharyngeal space have been reported. However, few reports describe parapharyngeal space tumours and the best surgical approach to these tumours. We retrospectively examined the surgical approaches we used to resect 22 parapharyngeal space tumours. In order to determine the best surgical approach for each tumour, we first subdivided the parapharyngeal space into six compartments, based on anatomical landmarks seen on computed tomography and/or magnetic resonance imaging scans. We then determined the location of each tumour relative to these six parapharyngeal space compartments. In our series of cases, we found that large tumours spanning the superior portion of the parapharyngeal space could be completely removed through a skull base approach. To remove a large tumour in the middle and inferior portion of the parapharyngeal space, a transparotid approach was the most suitable. Finally, a tumour in the inferior portion of the parapharyngeal space was best accessed through a transcervical approach.

A 75-year-old gentleman presented to our department with dysphagia, nocturnal cough and dysphonia. Clinical examination revealed a large parapharyngeal mass extending from the left nasopharynx to the glottis. A magnetic resonance imaging scan confirmed the lipomatous nature of the lesion and elegantly demonstrated its anatomy. We discuss the aetiology and management of such lesions and focus on the diagnostic radiology of the parapharyngeal space.

Two cases of deep lobe parotid tumours extending into the parapharyngeal space and causing obstructive sleep apnoea are described. Post-operatively, marked improvements in nocturnal hypoxic episodes and the symptoms of obstructive sleep apnoea were seen. Although minor salivary gland pleomorphic adenomas have been described as a cause of airway compromise, pleomorphic adenomata arising from the deep lobe of the parotid, causing proven obstructive sleep apnoea, have not previously been documented. The anatomy and common pathologies of the parapharyngeal space are discussed.

A granular cell tumour is a rare lesion of probable nerve sheath origin. It is typically benign but up to seven per cent may be malignant. Since its original description in the tongue in 1926, the tumour has been reported to occur at many other sites in the body. The authors report a case of a 49-year-old African woman with an oronaso-parapharyngeal granular cell neoplasm causing mild dysphagia. The location of this tumour, which has not been reported previously, posed a unique surgical challenge. An initial attempt to remove the lesion transorally was only partially successful because it was too tough and adherent for conventional surgical dissecting instruments. Complete resection, however, was achieved with a carbon dioxide laser via the same approach. This information may be helpful in the management of other similar cases in the future.

We report the clinical course in a 25-year-old male patient of neurofibromatosis with malignant triton tumour (MTT). Triton tumour is a peripheral nerve sheath tumour with rhabdomyoblastic differentiation. This is relatively rare tumour of head and neck region and only 26 cases have been reported to date. The present case is the first reported MTT of parapharyngeal space, one of the most aggressive course among all head and neck MTTs, resulting in the death of the patient within three months following surgical resection. The aggressive nature of this tumour necessitates adjuvant therapeutic measures in addition to radical surgery in order to obtain better survival rates.

The case of a 75-year-old lady with a large parapharyngeal pleomorphic adenoma excised via a transpalatal peroral technique is presented. This is a new approach to the parapharyngeal space not previously described. A laterally placed full thickness soft palate split from the superior pole of the tonsil to 1 cm proximal to the pterygoid hamulus provided good surgical access to the whole length of the parapharyngeal space and allowed complete tumour excision with minimal morbidity.

This report describes a 47-year-old male who had an occult papillary carcinoma of the thyroid present as a nodal involvement of the parapharyngeal space, in the retrostyloid compartment. To the best of our knowledge, this is an extremely rare condition.

Tumours of the parapharyngeal space are not common. The majority arise from the deep lobe of the parotid gland or neurovascular structures. We describe a case of fibromatosis, which has not previously been reported at this site.

This is the first description of successful surgical excision of a parapharyngeal (retrostyloid compartment) cyst remnant of the third branchial arch.

Chondrosarcoma is rarely found arising in the head and neck region. An unusual case arising in the parapharyngeal space in a male is reported and the differential diagnosis, pathology and treatment are discussed.