Anaesthetic management of a large parapharyngeal mass using electromyography monitoring

• Author Details:   
• Geetha Ramalakshmi
• Balasubramaniam Gayathri ^*
• Pranati Yerramilli
• Karthik Kanthan

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Managing parapharyngeal space tumours presents significant anesthetic challenges, particularly with airway access and the risk of neurovascular injury. A large pleomorphic adenoma extending into the parapharyngeal space was successfully excised via a transcervical mandibulectomy approach. Due to the anticipated difficulty in airway management, awake fiberoptic intubation was performed to ensure patient safety. Anaesthesia was maintained without neuromuscular relaxants using target-controlled infusions of propofol and fentanyl, allowing continuous neuromonitoring. Intraoperative nerve preservation was facilitated by electromyography (EMG) monitoring using an EMG endotracheal tube, which aided in the identification and protection of critical neural structures. Postoperative examination revealed normal vocal cord mobility with no signs of edema or nerve injury. The recovery period was uneventful, and the patient was discharged after 10 days. Follow-up at two months confirmed the absence of delayed nerve palsies, demonstrating a successful anaesthetic and surgical outcome.

Keywords: Electromyography, Pleomorphic adenoma, Airway management, Intraoperative nerve monitoring.