Endoscopy-Aided Combined Intraoral and Cervical Approach for a Huge Parapharyngeal Benign Tumor

Abstract

We introduce here our surgical approach for the removal of a huge parapharyngeal tumor in 3 cases. Surgery was done under general anesthesia using transnasal intubation. Transoral manipulation was performed first. Using a tongue retractor and an angle widener, a wide surgical field was provided. Incision was made on the palate around the tumor. Tumor was separated from the surrounding tissue, preserving the tumor capsule. Then, a 5-cm small skin incision was made. Both parotid and submandibular glands were pushed upward, and the parapharyngeal space was opened. The tumor was also separated from the surrounding tissue. These manipulations were done under endoscopic observation. Finally, the tumor was pushed laterally and safely removed intraorally. After removal of the tumor, the wounds were closed, and vacuum drainage was settled for a few days. No apparent problems, such as malocclusion and facial palsy, occurred, and the patients were free from disease for more than 10 years. For the removal of a large parapharyngeal tumor, the mandibular swing approach is usually used; however, this approach is invasive, and certain sequelae, such as facial wound and malocclusion, may occur. Our technique enables the safe and less invasive removal of such a huge parapharyngeal benign lesion.

Combined Use of Endoscopic Techniques and Virtual Surgical Planning for Intraoral Approach for Hemi-mandibular Resection and Reconstruction

“…Malignant lesions usually require wide resection, including surrounding soft tissues; implementing transoral removal remains difficult if using endoscopy as a monitoring method. 21 Therefore, only patients with benign tumors in the mandibles were tested in our study; up to 25-month follow-up results were satisfying, and no recurrence was found in any of these cases. We suggest that the indications should be chosen carefully.…”

Awake Intubation for a Case of Giant Parapharyngeal Space Tumor Using McGrath MAC® Video Laryngoscopeq

“…Nasal intubation might be considered a suitable airway choice in case of extirpation of the tumor. 3 We used a McGrath video laryngoscope and the fiber because the video laryngoscope has a better field of view than the classic laryngoscope, and the fiber was prepared as an alternative method in cases where it was difficult to expand the laryngeal deployment with the McGrath. According to a survey conducted on Canadian anesthesiologists, a video laryngoscope, such as the McGrath video laryngoscope, was selected as the first-choice in cases of difficult intubation.…”

“…Moreover, most of the available literature reported on the extraction or biopsy of the parapharyngeal space tumors instead of other types of surgery. 3 , 4 Herein, we report a case of successful awake intubation in a patient with a parapharyngeal space tumor scheduled for a bilateral endoscopic sinus surgery.…”

Endoscopy‐assisted transoral approach for parapharyngeal space tumors: Our experience and a systematic review of the literature

“…Similarly, tumors presenting solely as a laterocervical swelling (i.e., with no pharyngeal bulging during a clinical exam or imaging) will reasonably need a transcervical approach. For patients with favorable anatomy but with a large tumor or with a tumor that extends over the medial pterygoid muscle in the poststyloid compartment and/or that encases the internal carotid artery, a combined transoral/transcervical approach may be appropriate as even a small cervical incision may be crucial to obtain a complete excision 56,57 . Finally, patients with an MFMS < 3, favorable 8 Ts criteria, and with a tumor <6 cm in maximum diameter and located into the prestyloid compartment, have a reasonable chance to be fully treated by EATA: A practical algorithm to facilitate the identification of candidates to this approach is presented in Figure 4.…”