Erosive parapharyngeal space teratoma.

An erosive teratoma of the parapharyngeal space is described. Our patient at three months of age presented with an eight-week history of torticollis. Diagnosis was strongly suggested by CT scan which clearly demonstrated bony, fluid and intermediate densities suggestive of a teratoma. The tumor had eroded the petrous bone with inferior extension to the level of the hyoid cartilage. An angiogram revealed compromise of the internal carotid artery at the skull base. Surgical resection at five months removed the tumor from the right parapharyngeal space and included a portion of the petrous bone involving the contents of the middle ear and extending to the base of skull. All vital structures including the facial nerve, carotid artery and vagus nerve preserved. An intraoperative CSF leak was controlled with a muscle plug. To our knowledge, such an extensive teratoma eroding the petrous bone and base of skull, presenting as a neck mass, is the first reported case in the literature. The value of a CT scan as an aid in diagnosis of this tumor is stressed.