PMC7744222_01
Preoperative magnetic resonance imaging. (a) Axial T1 postcontrast image with fat suppression showing the slightly hyperintense well-defined right parapharyngeal cyst with mild smooth linear wall enhancement and no enhancement of contents, medially indenting nasopharyngeal wall and displacing carotid sheath vessels posterolaterally. (b) Sagittal T2 sequence showing the well-defined cyst extending to skull base and contents heterogeneously hyperintense with fluid-fluid level.
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It revealed a well-defined right parapharyngeal cystic lesion with nearly same dimensions, slightly T1 hyperintense with contents showing no contrast enhancement and heterogeneously T2 hyperintense with fluid-fluid level, demonstrating restricted diffusion of contents (indicating high proteinaceous material) but not in cyst wall, suggesting a rare second BCC location (Figure 1).
Intraoperative transoral excision views. (a) Vertical lateral pharyngeal wall incision exposing submucosal cyst. Soft palate catheter-retracted and ipsilateral tonsil suture-retracted to improve exposure. (b) Cyst wall grasped following planned evacuation of contents to facilitate lateral and superior blunt dissection off major neck neurovascular structures. (c) Resultant cavity filled with Fibrillar  Surgicel  layers before pharyngeal incision is closed. (d) BCC surgical specimen after complete excision.
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Surgicel  (Ethicon, LLC, San Lorenzo, Puerto Rico, USA) were applied to protect and obliterate the surgical cavity. Simple 4-0 Vicryl sutures were taken for pharyngeal incision closure (Figure 2).
Histopathological examination of resected specimen. (a) Low power view of an invaginated part of the cyst, lined by attenuated stratified squamous epithelium with abundant subepithelial lymphoid tissue (H & E, x100). (b) Close up view of a focally ulcerated area of the surface squamous epithelium encroached upon by heavy lymphocytic infiltrate including reactive lymphoid follicles (H & E, x400).
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Final histopathological specimen examination confirmed BCC diagnosis (Figure 3).
Postoperative (3-months) intraoral view showing complete incision healing (arrows).
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The patient has been followed-up for 24-months with no evidence of recurrence to date (Figures 4 and 5).
Postoperative (18-months) magnetic resonance imaging axial T1 postcontrast with fat suppression showing complete excision of right parapharyngeal cyst with no evidence of recurrence.
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The patient has been followed-up for 24-months with no evidence of recurrence to date (Figures 4 and 5).