Giant intraparotid hemangioma presenting with facial nerve palsy in an adult: a rare case report of successful surgical excision and sural nerve graft reconstruction

Abstract

Vascular anomalies of the parotid gland, particularly venous malformations presenting in adult populations, are rare entities that pose significant diagnostic and therapeutic challenges due to their infiltrative nature and proximity to vital neurovascular structures. While vascular tumors are common in the pediatric population, extensive vascular malformations involving the parapharyngeal space and encasing major cervical vessels in young adults are rare and require meticulous surgical planning. We present the case of a 19-year-old male presenting with a progressively enlarging mass on the left side of the face associated with trismus and difficulty chewing. The patient presented with established House-Brackmann Grade V facial nerve palsy. Advanced imaging, including contrast-enhanced MRI, identified a large vascular mass compromising the left parotid gland with extension into the parapharyngeal and retrostyloid spaces. The lesion encased the internal carotid artery and jugular vein. Given the suspicion of malignancy and progressive functional deficits, the patient underwent radical surgical excision of the mass. To address adequately the functional deficit, surgical facial reanimation was performed as a delayed procedure four months later using a sural nerve graft. Extensive parotid venous malformations in young adults can mimic malignant behavior through vessel encasement and nerve paralysis. A coordinated surgical approach involving complete excision and subsequent facial reanimation with nerve grafting represents an effective strategy for restoring facial symmetry and function.