Parapharyngeal Schwannoma Mimicking Peritonsillar Abscess in a Young Female: A Rare Case Report

Abstract

Parapharyngeal Space (PPS) tumours are responsible for 0.5% of head and neck cancers. Presenting features can mimic Peritonsillar Abscess (PTA). A differential diagnosis of PPS tumour should therefore be considered in young, systemically well patients with peritonsillar masses that are refractory to antibiotic therapy. This report focuses on a rare case of parapharyngeal schwannoma in an otherwise fit 29-year-old female, who presented with a three month history of a right sided oropharyngeal swelling and a sensation of ‘something’ in her throat. Blood tests, specifically full blood count and C-Reactive Protein (CRP) were normal and attempts at aspiration under local anaesthetic yielded no pus. As the patient showed no signs of improvement despite Intravenous (i.v.) antibiotics and steroid therapy; further investigations were initiated including Flexible Nasoendoscopy (FNE) and contrast enhanced Magnetic Resonance Imaging (MRI) of the neck. The FNE revealed a right sided parapharyngeal mass which was later confirmed on MRI scanning, measuring 7 cm in craniocaudal dimension arising from the deep lobe of the parotid gland. After a fine needle aspiration yielded inconclusive histological evidence, Multidisciplinary Team (MDT) discussion advised surgical excision. The patient underwent excision of the right parapharyngeal tumour and right partial parotidectomy via a transparotid and transcervical approach utilising a modified blair incision and a facial nerve monitor. Histology confirmed a parapharyngeal schwannoma. Postoperative outcomes have been reassuring as the patient has been disease-free four years postexcision.

Keywords

• flexible nasoendoscopy
• head and neck tumours
• oropharyngeal swelling