An Unusual Presentation of a Primary Parapharyngeal Space Warthins Tumour

Warthin's tumours of the deep lobe of the parotid gland can present as a parapharyngeal space swelling. This occasionally makes their diagnosis a somewhat significant challenge. We present a rare case of a primary parapharyngeal Warthin's tumour which presented unusually with a failure of Continuous Positive Airways Pressure (CPAP) therapy due to a choking sensation and excessive saliva production. Examination revealed the cause for the symptoms was due to a large left-sided oropharyngeal swelling, causing displacement of the tonsil and uvula deviation. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed a parapharyngeal space tumour, separate to the deep lobe of the parotid gland and histology found this to be a Warthin's tumour. This case is the first noted where this is a primary tumour, not connected to the parotid gland. Additionally, this case highlights the importance of a thorough oral cavity and oropharyngeal examination of patients presenting with Obstructive sleep apnoea, prior to commencement of CPAP treatment.