Parapharyngeal Cavernous Lymphangioma - A case report

Abstract

Lymphatic malformations of the head and neck, also known as lymphangiomas or cystic hygromas, are a diverse group of lesion. They represent benign hamartomatous tumours of lymphatic vessels with a marked predilection for the head, neck and oral cavity. Cavernous or microcystic lymphangioma, however, is composed of small lymphatic spaces and poses a therapeutic dilemma by its propensity to cause airway and feeding difficulties and by its tendency to recur despite extensive surgery. Case report: We present JB a 6 year old pupil who presented to clinic with 4 years history of recurrent sore throat. There was no dryness of the tongue, peri-areolar swelling, epistaxis nor snoring. On examination there was fullness in the right lateral wall of the oropharynx pushing towards the midline, with soft palatal bulging at the same site displacing the uvula to the left. The overlying mucosa appeared normal with no hyperemia or exudate. Other investigations were within normal limits. Intraoperatively there was a huge firm parapharyngeal mass (mainly muscular) involving the right side of the soft palate, as well as the superior, middle and part of the inferior constrictor muscle. Assessment of a parapharyngeal tumour was made with differentials of (soft palatal tumour or tonsillar tumour). The excised tissue was submitted for histology. Histological diagnosis of cavernous lymphangioma was made. Conclusion: Lymphangioma of the parapharyngeal space is a rare entity. It is difficult to diagnose purely on clinical examination, needing extra attention as it is deeply located in the neck spaces which contain neurovascular structure. Preoperative imaging plays a crucial role in identification of the lesion because it can help avoid complications during surgical exploration.