Incidental parapharyngeal ganglioneuroma: A case report on surgical management

Parapharyngeal ganglioneuromas are exceedingly rare, benign tumors of the sympathetic nervous system, with fewer than 40 reported cases in this specific anatomical space over four decades. They frequently remain asymptomatic until they reach a significant size, an their rarity contributes to a limited understanding of optimal management strategies. In this case report, a 16-year-old female presented with an incidental finding of a 5.2 x 3.9 x 2.0 cm right parapharyngeal space mass on a CT head. Further diagnostic imaging included a contrast-enhanced CT neck and an MRI neck. Flexible fiberoptic laryngoscopy was performed to confirm mass effect of the right lateral pharyngeal wall. Surgical excisional biopsy via an endoscope-assisted transoral approach resulted in subtotal resection due to proximity to the internal carotid artery. Pathology confirmed a benign mature ganglioneuroma (5.0 cm), positive for S100. She has been monitored with serial MRI imaging with evidence of known residual lesion and surrounding fibrosis. This case highlights the rare presentation and diagnostic challenges of parapharyngeal ganglioneuromas. Achieving complete surgical resection can be complex due to tumor adherence and proximity to vital structures. Comprehensive diagnostic workup, surgical excision, and regular surveillance remain crucial for optimizing outcomes in these benign yet challenging tumors. • Incidental finding of pediatric parapharyngeal ganglioneuroma • Excisional biopsy via endoscopic assisted transoral approach • Benign tumor surveillance with serial MRI