Parapharyngeal space tumors without mandibulotomy: our experience

Abstract

Parapharyngeal space (PPS) tumors are rare and benign in 80% of cases. Since surgeons first resected this anatomical region, the surgical approach to PPS bulks has been a hot topic due to their shape and the important structures involved. We present a series of patients treated with a transcervical or transcervical-transparotid approach to benign PPS tumors without mandibulotomy. Between May 2003 and March 2009, 18 patients (11 male and 7 female) with benign PPS tumors underwent a surgical resection, avoiding mandibulotomy. Average age of the patients was 49 years (range 3-76), average tumor size was 5.5 × 4 × 3 cm and histological examination of the resected tumors showed: seven pleomorphic adenomas of the deep parotid lobe, four schwannomas, two mycobacteriosis, two paragangliomas of the vagus nerve, one lipoma, one neurofibroma and one cavernous hemangioma. Seven patients underwent a transcervical approach, while 11 patients underwent a transcervical-transparotid approach. Excision of benign PPS tumors is possible without mandibulotomy even in the case of a large tumor mass, but exposure with the mandible in situ is certainly poor. Avoiding mandibulotomy reduces patient morbidity and hospital stay. In our experience, mandibulotomy can be avoided in most cases of benign PPS tumors leaving this procedure for malignant tumors or in patients with very poor exposure

Potential Surgical Exposure of the Parapharyngeal Internal Carotid Artery by Endonasal, Transoral, and Transcervical Approaches

“…Subsequently, others have reported the successful surgical treatment of PPS lesions via multiple transcervical approaches. 1,2,4,5,[21][22][23] This study provides evidence supporting that the transcervical-submandibular and the transcervical-transparotid approaches provide adequate exposure for the lesions in the lower and middle parts of the PPS. Both of these approaches can access the pre-and poststyloid PPSs but neither enables reaching the cranial base under direct visualization.…”

“…1,2 Multiple open surgical approaches have been advocated, each offering varying degrees of exposure and functional outcomes. [3][4][5] In general, however, an increase in surgical exposure requires greater mobilization or resection of normal tissue, and therefore, is associated with greater morbidity.…”

Surgical treatment of parapharyngeal space tumors: A report of 29 cases

“…The associated CNs are VII, IX, X, XI and XII (31). The original nerve of the tumor tends to be injured following the resection of neurogenic tumors, including schwannomas and paragangliomas.…”

A Large Extra Cranial Cystic Trigeminal Schwannoma of the Parapharyngeal Space – Exploring the Right Approach

“…The facial nerve is identified and dissected, a parotidectomy is performed and the PPS space is delineated. Although the overall exposure is limited, well encapsulated, radiologically benign appearing large tumors such as a schwannoma can be safely and carefully removed with acceptable cosmetic or functional outcomes [9,10], as was done for our patient.…”

“…Trigeminal schwannomas are more likely to contain cystic components and are more varied in appearance than acoustic schwannomas, as was also seen in our patient. Most of the time, the diagnosis can only be confirmed on the histological Surgery is the mainstay of treatment for schwannomas of the parapharyngeal space (PPS) [3][4][5][6][7][8][9][10]. The choice of operation is mainly determined by the relationship between the tumor and the nerve of origin.…”