Fig 3. Digital Subtraction Angiography: (a)Pre
embolization: Coronal- showing feeding vessels in the tumour mass
originating from the ECA with a significant tumour blush,
(b)Post embolization: post coil embolization showing
significant reduction in the feeding vessels and the tumour blush
The tumor excision required combined approach (Transparotid,
Transcervical and Mandibular swing approach) (Fig 4a, 4b, 4c) with intra
op findings of large vascular tumor of size 8.0x7.5cm (Fig 5a, 5b) in
left parapharyngeal space infiltrating into deep lobe of parotid
laterally, reaching pterygoid plate medially extending up to skull base
superiorly and up to angle of mandible inferiorly. Facial nerve was
identified and through transparotid approach tumor was reached
preserving all the branches of facial nerve. Transcervical and mandible
swing were also required for adequate access and excision of the tumor
as it was adherent with lot of vascularity. Paramedian mandibulotomy was
employed for mandible swing. Brisk bleeding encountered during surgery
from dilated tumor vessels.