Transcervical-transparotid skull base approach for giant deep lobe pleomorphic adenoma with parapharyngeal and retropharyngeal extension: avoidance of mandibulotomy through styloidectomy.

Deep lobe pleomorphic adenomas that extend into the parapharyngeal and retropharyngeal spaces pose substantial exposure challenges, and mandibulotomy is traditionally employed for tumors approaching the skull base. This technical note describes a giant pleomorphic adenoma (8.4 × 7.1 × 4.0 cm) involving the superficial and deep parotid lobes with significant parapharyngeal, retropharyngeal, and skull base extension in a 33-year-old man. The tumor was removed en bloc via a transcervical-transparotid skull base approach without mandibulotomy. The critical technical maneuver was enlargement of the stylomandibular corridor through release of the stylomandibular ligament and complete styloidectomy, which also permitted significant anterior mandibular subluxation. This combination transformed the narrow parapharyngeal tunnel into a workable exposure field, allowing safe medial and superior dissection without capsule violation. The patient underwent total parotidectomy with preservation of all facial nerve branches and experienced only transient marginal mandibular weakness that resolved fully. This case highlights a reproducible technique permitting mandibulotomy-free removal of large, medially and superiorly extending deep lobe parotid tumors.