The addition of MWS and a solid test meal increases the diagnostic yield of HRM studies in patients with symptoms after fundoplication and identifies additional patients with outlet obstruction who benefit from endoscopic dilatation.

BackgroundParapharyngeal space biopsy is an important investigation in the management of parapharyngeal space tumours. These tumours are relatively rare and the surgeon is often faced with a wide range of differential diagnoses. There are several ways to access the parapharyngeal space, with varying degrees of associated morbidity.MethodsThis paper describes a seldom used, but a simple and safe, image-guided endoscopic approach to parapharyngeal space biopsy that enables tissue to be obtained transnasally. The procedure is conducted under general anaesthesia using computed tomography image guidance via the LandmarX system, with transnasal access to the parapharyngeal space achieved using a sampling needle.ResultsThis procedure is relatively simple, safe and reproducible. It is a less invasive approach to parapharyngeal space biopsy, and one which has been successfully used by the senior author for years without any significant morbidity.ConclusionTransnasal image-guided endoscopic aspiration or biopsy of the parapharyngeal space is a novel technique that has not been previously described.

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Masses in the PPS are relatively rare but do account for 0.5% of all masses arising in the head and neck 1 . Histological identification of the PPS tumour allows the surgeon to make informed decisions on management and can also dictate prognosis. The 5 and 10-year survival for a benign lesion is 100%. Conversely, in malignancy the 5-year survival drops to 82-100% and the 10-year survival drops to 40-74%. This dramatic fall in survival demonstrates a clear role for establishing the histology in the management of the PPS tumour.There are a number of ways to access the PPS with some degree of morbidity, including needle biopsy through the mandibular or maxillofacial areas 4 , biopsy via the buccal space 6 , and directly through the skin or oral mucosa if the lesion is palpable 5 .

Number of patients 11 8 % Total thyroidectomy 54.5% 87.5% % Completion thyroidectomy 45.5% 12.5% % patients with hypocalcemia 45.5% 25.0% % requiring IV Calcium 18.0% 25.0% PTH & Bone profile checked post-op 9.0% 100.0%