Venous malformation of the parapharyngeal space: Two surgical case reports and a literature review

Background: Occupied lesions arising in the parapharyngeal space (PPS) are rare. Among these, venous malformations are particularly rare, and very few case reports have appeared. Methods: Two patients with venous malformations in the PPS were operated on by the same surgeon. Here, we report the patient and tumor characteristics, symptoms, preoperative examinations and diagnoses, treatment plans, intraoperative findings and refinements, histological diagnoses, and postoperative complications, in combination with a review of past reports. Results: The patients were two men aged 37 and 29 years who had persistent swelling and pain in the right parotid region. Imaging showed masses in the prestyloid compartment of the right PPS with maximum diameters of 69 and 54 mm, respectively. Fine needle aspiration cytology (FNAC) showed blood cell components only in both cases and no diagnosis could be made. Both cases were treated with surgery. The facial nerve was identified and preserved, and the soft lesion was removed using a transcervical-parotid approach. Post-operative histological diagnosis was venous malformation in both and no post-operative recurrence was seen. Conclusion: Venous malformations arising in the PPS are clearly distinguishable from major PPS tumors. The preoperative diagnosis and intraoperative refinements reported here were effective in these cases. Keywords: Parapharyngeal space, Venous malformation, Hemangioma, Surgical case