Transoral excision of a parapharyngeal thyroglossal duct cyst and parapharyngeal second branchial cleft cyst: A report of two rare cases in adult patients with a comprehensive literature review

Thyroglossal duct cysts (TDCs) and branchial cleft cysts (BCCs) are common congenital neck anomalies that typically present in children. However, their occurrence in the parapharyngeal space is exceedingly rare. Standard management usually involves elective resection via a transcervical approach. We report two atypical cases in adult patients where these masses were located in the parapharyngeal space and were successfully managed with transoral resection. Patient A, an 81-year-old male, presented with a parapharyngeal TDC causing intermittent compressive symptoms for over five decades. Patient B , a 56-year-old male, had an incidentally discovered parapharyngeal BCC. Both lesions were transorally excised without complications. We discuss the imaging characteristics, the importance of maintaining a wide differential diagnosis, and the feasibility of transoral resection for these rare presentations, especially when the masses are situated superiorly and medially in the parapharynx. A comprehensive literature review of parapharyngeal TDCs and BCCs is provided, highlighting the rarity of these congenital neck masses in such locations and the role of transoral excision in their management.