DR. DANG TRIEU HUNG AND A COMPLEX PAROTID TUMOR SURGERY: THE CHALLENGE OF ACCESSING THE DEEP PARAPHARYNGEAL SPACE.

Surgery for parotid gland tumors is one of the major challenges in head and neck surgery, particularly when the tumor grows deeply and is close to vital structures such as the carotid artery and cranial nerves. This article presents a complex surgical case performed at Hanoi Medical University Hospital, showcasing the diagnostic process, surgical planning, and precise intervention used to manage a difficult-to-access tumor.

1. Overview of the Treatment Case

Parotid gland tumors are not uncommon. Though most are benign, they can pose serious risks if they grow large and invade critical anatomical areas. This clinical case Treatment at Herident led by TS.BSNT. Đặng Triệu Hùng involved a 59-year-old male patient with a large parotid tumor on the left side compressing the parapharyngeal space and located near vital neurovascular structures such as the carotid artery and cranial nerves.

The complexity of this case demanded an accurate diagnosis, detailed surgical planning, and advanced surgical skills to fully remove the tumor while preserving essential facial and neck functions.

2. Initial Condition

Gender: MaleAge: 59
The patient reported pain in the left jaw angle, especially while chewing, for the past six months. He had received medical treatment.
Recently, the pain returned, affecting neck muscles, though without swelling, fever, or discharge. He then sought treatment at our hospital.

3. Diagnosis & Treatment Indication

Examined by: Doctor of Philosophy (PhD) DANG TRIEU HUNG

Clinical findings:

• Swelling at the left jaw angle with no abnormalities in soft tissues.
• MRI revealed a large tumor in the left pterygomandibular region with the following features:
• Mass located in the left parapharyngeal space, size 57 x 27 mm, relatively smooth borders
• Unclear demarcation from the deep lobe of the left parotid gland.
• Adjacent to the left carotid artery, compressing the pharynx.

Critical Note: The parapharyngeal space contains several vital structures including cranial nerves, internal carotid artery and vein, esophagus, and trachea. Diagnosing, accessing, and surgically managing tumors in this area requires extreme caution to avoid serious complications like acute hemorrhage or cranial nerve injury.

Treatment indication:
The patient was scheduled for tumor removal surgery to prevent compression of adjacent structures and potential progression.

4. Treatment Procedure

Due to the tumor’s size and proximity to critical structures, a multidisciplinary team proposed the following: Preoperative embolization to minimize bleeding, mandibular osteotomy via a skin incision, tumor resection through direct access.

Surgical steps included:

• Skin incision from beneath the left ear to the chin to expose the mandibular border.
• Ligation of the left facial artery.
• Extraction of tooth #41, followed by a midline mandibular osteotomy, dissection to access the lateral pharyngeal wall and expose the tumor.
• Total removal of the tumor (~3x7 cm), which was firm and well-bordered.
• Realignment of the mandible and dental arch reconstruction.
• Surgical field irrigation and placement of a closed drain.

Result

Despite the tumor’s deep location and challenging access, the surgery was successfully completed after more than two hours of dedicated effort by Dr. Hung and the entire surgical team. Postoperatively, the tumor was completely removed, the patient was stable and alert, and the surgical drain functioned well.

5. Clinical Analysis

The parotid gland is the largest salivary gland, located near the mandibular angle. While parotid tumors are mostly benign and can occur at any age, their symptoms may be vague—often limited to gradual swelling.

The gland has two lobes: superficial and deep. The superficial lobe is related to facial nerves and vessels, while the deep lobe is adjacent to the parapharyngeal space. Tumors in the deep lobe can compress or extend into this space.

Tumor size and biological characteristics determine the optimal surgical approach. Careful imaging analysis is key for planning safe and effective tumor excision.

For deep, large parotid tumors, surgery becomes highly complex due to difficult access and nearby critical structures. Accurate diagnosis, inter-specialty collaboration, and surgical expertise are essential for success and minimizing complications.

DR. DANG TRIEU HUNG – EXPERTISE GUARANTEED AT HERIDENT DENTAL CLINIC

Herident Dental Clinic is led and clinically endorsed by Dr. Dang Trieu Hung, PhD – Deputy Head of Maxillofacial Surgery at Hanoi Medical University Hospital. With over 20 years of clinical experience, especially in complex maxillofacial surgeries, Dr. Hung ensures a strong foundation of expertise at Herident. The clinic combines modern techniques, standardized protocols, and a highly trained team to provide safe and effective treatment—even in highly specialized and complex cases.

Contact the Herident Hotline at 1900 5089 or visit our clinic directly for consultation and care by Vietnam’s top dental professionals.