Giant Kimura Disease of the Parotid Region Managed by Modified Rhytidectomy: A Case Report and Review of Surgical Treatment Strategies.

Kimura disease (KD) is a rare, chronic inflammatory disorder that typically presents as a painless mass in the head and neck region. It is histologically characterized by lymphoid follicular hyperplasia, eosinophilic infiltration, and vascular proliferation. We report the case of a 66-year-old Japanese man with an 18-year history of recurrent, treatment-resistant KD involving the right parotid region. He presented with a large (9×6.5 cm), well-defined, firm, immobile mass that caused significant facial asymmetry and earlobe ptosis. Surgical excision was performed using a modified rhytidectomy incision, which provided wide exposure and allowed for complete removal with minimal visible scarring. A superficial parotidectomy was performed without elevating the superficial musculoaponeurotic system layer, thus preserving postoperative facial symmetry. Histopathologic examination confirmed KD, revealing follicular hyperplasia with dense eosinophilic infiltration, consistent with the hallmark features of the disease. Diffusion-weighted imaging demonstrated a hyperintense lesion with no evidence of necrosis or invasive characteristics. The patient had an uneventful postoperative course and retained House-Brackmann Grade I facial nerve function. At his six-month follow-up, he exhibited restored facial symmetry, inconspicuous scarring, and no clinical or radiologic evidence of recurrence. This case highlights the importance of integrating aesthetic surgical principles into the management of benign inflammatory lesions in the parotid region, achieving excellent functional and cosmetic outcomes. Long-term surveillance remains ongoing to monitor for potential recurrence.