<Case Report>Extirpation with cutting of the stylomandibular ligament and external cervical incision of large dumbbell type parotid pleomorphic adenomas, two case reports

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We report 2 cases of dumbbell type large parotid pleomorphic adenomas. In these cases, the stylomandibular ligament was cut and an external cervical approach was used to resect the tumor from surrounding tissues. The tumor in case 2 was elastic hard, and could be extirpated en bloc without damage to the tumor capsule or postoperative complications. The tumor in case 1 was soft and fluctuated and its capsule was broken in some locations and leakage of the tumor contents was noted on extirpation. Combined oral and cervical approaches have commonly been used for extirpation of large dumbbell tumors of the parotid gland. This method must divide a tumor at this narrow portion and separately extirpate both a tumor from oral cavity and the other tumor from external cervix. However, it is important that the capsule should not be damaged. The external cervical approach alone can be used and a risk of damaging the capsule will decrease if the stylomandibular ligament is cut. Because cutting the stylomandibular ligament freed the tumor from the parapharyngeal space under visual observation and could draw out a tumor from parapharyngeal space to outside of the mandible without cutting ramus of mandible.
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