Robotic Excision of a Parapharyngeal Pleomorphic Adenoma: Pushing the Limits of Size

Abstract

Objective: To describe transoral robotic approach (TORS) as a paradigm-changing means of surgical management of a large (> 6 cm) parapharyngeal space (PPS) pleomorphic adenoma beyond the conventional tumor size limitations of the approach.

Methods:
Design: Case Report
Setting: Tertiary National University Hospital
Patient: One

Results: A 34-year-old man with a progressively enlarging oropharyngeal mass over two years was ultimately diagnosed with a 7 × 4.8 × 5.7 cm pleomorphic adenoma of the right PPS. He underwent resection via a transoral robotic approach using the da Vinci Si® surgical system. Preoperative imaging showed a well-circumscribed tumor without neurovascular invasion, allowing for safe robotic dissection. Complete tumor excision was achieved without capsular rupture or postoperative complications. This case demonstrates that TORS can be effectively employed in select cases involving large PPS tumors, provided careful preoperative assessment and surgical planning are performed.

Conclusion: This case supports the expanding indications for TORS in the management of PPS tumors beyond the previous conventional 6 cm threshold. Favorable tumor characteristics, multidisciplinary planning, and familiarity with PPS anatomy are essential for optimizing outcomes. TORS, when applied judiciously, allows for better visualization and dissection with excellent cosmetic and functional results even for large tumors, challenging traditional surgical paradigms.