Pourfour du Petit Syndrome Following Superficial Parotidectomy: A Case Report

Pourfour du Petit syndrome (PDPS) is a rare oculosympathetic hyperactivity disorder and is considered the clinical counterpart of Horner syndrome, resulting from irritation of the cervical sympathetic pathway. We report a 62-year-old man with no significant medical history who developed PDPS in the early postoperative period after left superficial parotidectomy for a painless, mobile 3 × 3 cm mass. Preoperative imaging and fine-needle aspiration biopsy were consistent with a Warthin tumor. Within the first postoperative hour, the patient developed left-sided anisocoria with mydriasis, conjunctival hyperemia, and hemifacial sweating. Neurological and ophthalmological evaluations excluded acute central and ocular causes. Given the lesion's anatomical proximity to the external carotid artery, the findings were attributed to transient irritation of the periarterial sympathetic plexus secondary to surgical manipulation. The patient improved clinically without specific pharmacologic treatment, was discharged on postoperative day 3, and showed complete resolution of symptoms at the 6-month follow-up. PDPS is a rare postoperative complication that should be considered after head and neck surgery in patients presenting with anisocoria or other autonomic findings. Prompt evaluation is important to exclude serious neurological and ophthalmological conditions.