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.