Transoral Resection of a Retropharyngeal Myxoma: A Case Report

• Published in: Skull base 2011-02, Vol.21 (S 01)
• Main Authors: White, James R., Weiss, Sean, Walvekar, Rohan R., Mason, Stephen E., Anderson, Dwayne
• Format: Article
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2011-1274380

Objectives: The purpose of this report is to describe an unusual presentation of a retropharyngeal myxoma and discuss clinical concerns regarding this pathology and its site of occurrence. Results: A 71-year-old asymptomatic woman presented to our service with an incidental finding of a retropharyngeal tumor. Imaging studies (MRI and CT scan) and a complete head and neck examination confirmed the presence of a 5 cm × 3 cm × 2 cm mass in the retropharynx that had no communication with the vertebral column but was intimately involved with the mucosa of the pharynx. A transoral fine-needle aspiration showed spindle cells of benign nature, suggesting a possible spindle-cell neoplasm. The patient was advised to have surgical excision via a cervical or possible transoral route. A presurgical swallowing consultation was obtained to inform the patient regarding the possibility of postoperative swallowing dysfunction associated with interruption of pharyngeal plexus as a consequence of the surgical approach to the tumor. A transoral excision of the tumor was possible with no intraoperative complications. The tumor was not completely capsulated and was intertwined with the pharyngeal musculature. Complete tumor excision with exposure of the carotid artery signifying adequate lateral dissection was possible via the transoral route. Histopathology was a cellular myxoma. Postoperative dysphagia secondary to pharyngeal muscle dysfunction was significant. The patient required postoperative swallowing therapy and nasogastric tube feeding for 2 weeks before regular oral intake was possible. A postoperative CT scan confirmed complete tumor excision. Conclusion: We present the second case of a myxoma in the retropharynx reported in English literature. Transoral excision is a safe, feasible, and cosmetically appealing option for these tumors. The intimate involvement with the retropharyngeal musculature by these tumors can lead to pharyngeal muscle dysfunction and postoperative dysphagia that may require intensive swallowing rehabilitation. Preoperative swallowing evaluation and counseling regarding postoperative dysphagia and management are recommended.