A 32-year-old male presented with a left preauricular swelling that had progressively changed in size over four years, accompanied by pulsatile tinnitus. He reported no known drug allergies and denied recent flu-like symptoms.

Laboratory studies, including blood count, thyroid and renal function, glucose and viral screening, were unremarkable. Ultrasound showed an ill-defined hypoechoic hypervascular nodule (about 38 × 20 × 23 mm) in the posterior medial left parotid with dilated tortuous vessels. MRI demonstrated a left preauricular AVM supplied by branches of the left external carotid artery, with associated inflammatory change in the external auditory canal and mastoid air cells.

A left parotidectomy was performed under general anaesthesia through a lazy-S incision. The facial nerve and major branches were identified and preserved, haemostasis was secured, and a corrugated drain was placed.

Parotid tissue showed benign salivary gland tissue with reactive lymph nodes and a vascular malformation in the soft tissue. No malignancy was identified.

Recovery was stable without significant complications. The patient was discharged with follow-up for the surgical site and possible recurrence of symptoms.