Extension of a Huge Pleomorphic Parotid Adenoma to the Deep Spaces of the Face: Case Report and Literature Review

The aim of this report is to discuss and highlight the diagnostic algorithm and surgical approach for giant pleomorphic adenomas of the parotid gland arising in the deep lobe and extending into the deep spaces of the face. We present the case of a 58-year-old female with a giant pleomorphic adenoma of the deep lobe of the parotid gland. Diagnosis was based on magnetic resonance imaging (MRI) cytology and histology. The tumor was successfully removed using a cervical-transparotid approach while preserving the facial nerve, assisted by external manual expression. A thorough preoperative diagnostic algorithm is essential before approaching such lesions. Fine needle aspiration cytology or biopsy is, in our opinion, mandatory to avoid unexpected histological findings. The surgical approach should provide excellent visibility and wide exposure to ensure the safety of local neurovascular structures.