Modified mandibulotomy as an approach to parapharyngeal space tumors: a case report

Background A mandibulotomy approach has been introduced for removal of posteriorly-based tumors of the oral cavity, oropharynx, and certain parapharyngeal tumors with minimum morbidity. Case presentation A middle-aged male presented with a left-sided upper neck mass for last year and difficulty in swallowing for the past six months. A previous history of sclerotherapy and incision and drainage was present and a histopathological examination report from the incision and drainage-derived tissue was suggestive of lymphangioma. On examination, a single soft globular swelling measuring approximately 6 × 4 cm in the left infra-auricular region and a scar of previous incision and drainage measuring approximately 1 × 0.5 cm was present. Oropharynx: tonsillar bulge was present and reaching up to the uvula. Contrast-enhanced MRI revealed an enhancing lesion suggesting a vascular tumour affecting the pre and post-styloid compartment. The patient underwent surgical excision of the lymphangioma by a modified mandibulotomy approach to improve bony stability, avoiding lip split incision and tooth extraction for medically resistant lymphangioma. So, we introduced our modified technique of mandibulotomy in cases of medically resistant parapharyngeal space tumors with a modified lifting step osteotomy with a thin saw blade. Conclusion The modified mandibulotomy approach provides a safe and effective means of tumor resection and this technique not only ensures complete tumour resection but also maintains the integrity and functionality of the mandible.