Surgical management of primary parapharyngeal space tumors: a 10-year review

Abstract

All of the patients underwent pre-operative imaging before surgery, and intra-operative endoscopic detection was selectively used for large, deep tumors. Complete resection of the tumor was used in 158 patients (95%), with a transcervical surgical approach applied in 144 cases (84%). Of 167 tumors, 150 (90%) were benign and 17 (10%) were malignant, with neurilemmoma/schwannoma as the most frequent pathology (42%). Surgical complications were reported in 26 patients (15%), most commonly unilateral paralysis of the vocal cords (6%). Two patients (1%) presented with recurrence, on average 2.5 years (range = 1-4 years) after initial excision, and the mean follow-up time was 3.8 years (range = 10 months-10 years).

Contemporary management of primary parapharyngeal space tumors

“…These global data come from recent studies of patients with PPS tumors . Different proportions can be found in some series.…”

“…Similar results have been reported by Fan et al Endoscope‐assisted transoral resection provides a wider view, reducing the risks of neurovascular injury or capsule rupture and allowing resection of large tumors; those tumors surrounded major vascular structures or with large lateral extension are not suitable. Endoscopy may also be used to overcome some of the limitations of external conventional approaches . It may be useful to visualize and dissect structures surrounding the tumor especially in the upper PPS, when reaching the skull base .…”

“…Endoscopy may also be used to overcome some of the limitations of external conventional approaches. 12 It may be useful to visualize and dissect structures surrounding the tumor especially in the upper PPS, when reaching the skull base. 68 Furthermore, endoscopy provides an excellent visualization of areas beyond the line of direct sight and enables confirmation of adequate hemostasis and the absence of residual tumor before closure.…”

Endoscopic transoral approach for resection of retrostyloid parapharyngeal space tumors: Retrospective analysis of 16 patients

“…1,2 A variety of approaches have been used for the resection of PPS tumors including transcervical, transparotid, transcervical-transparotid, transcervical-mandibulotomy, endoscopic transnasal, transoral, transoral-transcervical, endoscopic transoral, and transoral with robotic assistance. [3][4][5] Lateral approaches have associated sequelae and potential complications such as scaring, potential damage to the facial nerve, salivary fistula, and morbidity caused by mandibulotomy. 6 In addition, the transcervical approach also has challenges in exposure of the superior aspect of the tumor adjacent to the skull base.…”

Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space

“…Venous bleeding from the pterygoid plexus 26 may be copious and should be anticipated when planning any surgery involving the infratemporal fossa and UPPS. 14,27 The extent of the pterygoid plexus is variable, but the deep pterygoid plexus is always evident at the medial aspect of lateral pterygoid muscle. 10 When dissecting the lateral pterygoid muscle off the lateral pterygoid plate via a traditional endoscopic transpterygoid approach, bleeding from the pterygoid plexus may obscure visualization.…”