Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images

2007 ◽  
Vol 122 (6) ◽  
pp. 628-634 ◽  
Author(s):  
S Kanzaki ◽  
H Nameki
Keyword(s):  
Surgical Approach ◽  
Parapharyngeal Space ◽  
Surgical Approaches ◽  
Anatomical Landmarks ◽  
Resonance Imaging ◽  
Large Tumour ◽  
Transcervical Approach ◽  
Skull Base Approach ◽  
Inferior Portion ◽  
Superior Portion

AbstractMany approaches to the parapharyngeal space have been reported. However, few reports describe parapharyngeal space tumours and the best surgical approach to these tumours. We retrospectively examined the surgical approaches we used to resect 22 parapharyngeal space tumours. In order to determine the best surgical approach for each tumour, we first subdivided the parapharyngeal space into six compartments, based on anatomical landmarks seen on computed tomography and/or magnetic resonance imaging scans. We then determined the location of each tumour relative to these six parapharyngeal space compartments. In our series of cases, we found that large tumours spanning the superior portion of the parapharyngeal space could be completely removed through a skull base approach. To remove a large tumour in the middle and inferior portion of the parapharyngeal space, a transparotid approach was the most suitable. Finally, a tumour in the inferior portion of the parapharyngeal space was best accessed through a transcervical approach.

Myxofibrosarcoma of the neck

2006 ◽  
Vol 120 (10) ◽  
pp. 872-874 ◽  
Author(s):  
T Udaka ◽  
H Yamamoto ◽  
T Shiomori ◽  
T Fujimura ◽  
H Suzuki
Keyword(s):  
Parapharyngeal Space ◽  
Clinical Course ◽  
Low Grade ◽  
Resonance Imaging ◽  
Transcervical Approach ◽  
Low Intensity ◽  
Mri Scans ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Tentative Diagnosis

We report a rare case of myxofibrosarcoma arising in the neck. A 55-year-old man presented with a two-year history of left-sided, painless, submandibular swelling. Computed tomography and magnetic resonance imaging (MRI) revealed an 80 × 35 mm, well defined, lobulated, submandibular tumour extending to the parapharyngeal space. The tumour showed uniformly low intensity and marked hyperintensity in T1- and T2-weighted MRI scans, respectively, and was scarcely enhanced by gadolinium. A tentative diagnosis of lymphangioma or plunging ranula was made, and the patient underwent local injection of OK-432, which proved to be ineffective. Resection of the tumour was then performed via a transcervical approach. The tumour was histopathologically and immunohistochemically diagnosed as a low-grade myxofibrosarcoma. The patient's post-operative clinical course was uneventful, and the patient was free of disease 27 months after surgery. The pathology, clinical characteristics and treatment of myxofibrosarcoma are bibliographically reviewed.

scholarly journals Deconstruction of the Surgical Approach to the Jugular Foramen Region: Anatomical Study

2018 ◽  
Vol 80 (05) ◽  
pp. 518-526
Author(s):  
Jaafar Basma ◽  
L. Madison Michael ◽  
Jeffrey M. Sorenson ◽  
Jon H. Robertson
Keyword(s):  
Surgical Approach ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Surgical Anatomy ◽  
Cervical Region ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
Microsurgical Anatomy ◽  
Anatomical Landmarks ◽  
Transcervical Approach

Abstract Introduction The jugular foramen occupies a complex and deep location between the skull base and the distal-lateral-cervical region. We propose a morphometric anatomical model to deconstruct its surgical anatomy and offer various quantifiable target-guided exposures and angles-of-attack. Methods Six cadaveric heads (12 sides) were dissected using a combined postauricular infralabyrinthine and distal transcervical approach with additional anterior transstyloid and posterior far lateral exposures. We identified anatomical landmarks and combined new and previously described contiguous triangles to expose the region; we defined the jugular and deep condylar triangles. Angles-of-attack to the jugular foramen were measured after removing the digastric muscle, styloid process, rectus capitis lateralis, and occipital condyle. Results Removing the digastric muscle and styloid process allowed 86.4° laterally and 85.5° anteriorly, respectively. Resecting the rectus capitis lateralis and jugular process provided the largest angle-of-attack (108.4° posteriorly). The occipital condyle can be drilled in the deep condylar triangle only adding 30.4° medially. A purely lateral approach provided a total of 280.3°. Cutting the jugular ring and mobilizing the vein can further expand the medial exposure. Conclusion The microsurgical anatomy of the jugular foramen can be deconstructed using a morphometric model, permitting a surgical approach customized to the pathology of interest.

A Study of Primary Parapharyngeal Space Tumors in a Tertiary Care Center

2016 ◽  
Vol 8 (1) ◽  
pp. 13-17
Author(s):  
Nadia Shirazi ◽  
SS Bist ◽  
Vinish Agarwal ◽  
Lovneesh Kumar ◽  
Mahima Luthra
Keyword(s):  
Parapharyngeal Space ◽  
Care Center ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Clinicopathological Features ◽  
Surgical Approaches ◽  
Tertiary Care Center ◽  
Ct Guided ◽  
Transcervical Approach ◽  
Parapharyngeal Space Tumors

ABSTRACT Objectives This study was conducted to evaluate the demographic profile, clinicopathological features, and surgical approaches used to treat primary parapharyngeal space tumors. Materials and methods This was a retrospective study of the primary parapharyngeal space tumors treated surgically from April 2012 to March 2015 in a tertiary care teaching center. The study population included 16 cases. The inflammatory lesions and secondary metastasis in parapharyngeal space were excluded. The clinicopathological features, surgical management, and outcome of all the cases were analyzed. Observations The gender distribution was 56.2% males and 43.7% females. The median age was 38 years with range from 16 to 62 years. The most common presenting symptom was neck swelling in 87.5% cases, and oropharyngeal bulge was the most common examination finding in 100% cases. Magnetic resonance image was done in 87.5% cases and contrast computed tomography (CT) scan in 31.25% cases, while 25% cases underwent both. The tumor was in the pre-styloid compartment in 62.5% cases and post-styloid in 31.25% cases. In 75% cases, cytology was done directly, while in 25% cases, CT–guided cytology was performed. Cytological diagnosis was histologically correlated in 81.2% cases while changed in 18.7% cases. On histology, 87.5% cases were benign and 12.5% were malignant. The most common histological variant was pleomorphic adenoma in 56.25% cases. The most common surgical approach used was transcervical in 75% cases. Mean tumor size was 7 cm. Complications occurred in 12.5% cases. Conclusion Imaging modalities in combination with fine needle aspiration cytology are a very good diagnostic tool before planning for intervention. The transcervical approach is an excellent technique to deal with small to moderate-size tumors and even for large well-defined tumors. How to cite this article Bist SS, Kumar L, Agarwal V, Shirazi N, Luthra M. A Study of Primary Parapharyngeal Space Tumors in a Tertiary Care Center. Int J Otorhinolaryngol Clin 2016;8(1):13-17.

scholarly journals Transzygomatic anterior infratemporal fossa approach and high cervical approach for resection of infra temporal fossa and parapharyngeal space solitary fibrous tumours

2019 ◽  
pp. 492-497
Author(s):  
Kazumi Ohmori ◽  
Shiduka Kamiyoshi ◽  
Taku Takeuchi ◽  
Takanori Fukushima ◽  
Takashi Tsuduki ◽  
...  
Keyword(s):  
Parapharyngeal Space ◽  
Infratemporal Fossa ◽  
Cranial Nerves ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Middle Fossa ◽  
Temporal Fossa ◽  
Solitary Fibrous Tumours ◽  
The 1960S ◽  
Superior Portion

The infratemporal fossa (ITF) is the region under the floor of the middle fossa giving passage to most major cerebral vessels and cranial nerves.(1) It is closely related to important adjacent regions such as the middle fossa, pterygopalatine fossa, orbit, and nasopharynx.(2) Due to the anatomical complexity in the ITF, surgical removal of the lesions in or around it is still challenging.(3) Since the 1960s, many surgeons have reported various surgical approaches. the preauricular transzygomatic approach via a transcranial route was reported to be used for exposure of the antero-superior portion of the ITF (2,3). Solitary fibrous tumours (SFTs) were first described by Klempere and Rabin in 1931 as spindle-cell tumours originating from the pleura.(4) With the exception of myopericytoma, infantile myofibromatosis and HPC-like lesions of the sinonasal tract showing myoid differentiation, all other HPC like lesions are best considered as subtypes of SFT.(5) Only a few cases of SFT have been described in the literature involving the skull base and parapharyngeal space.(6–8) The purpose of this article is to show anatomical dissections involving this surgical approach and to evaluate our surgical experience using it.

scholarly journals Surgical approach to parapharyngeal space tumors

2011 ◽  
Vol 58 (4) ◽  
pp. 61-66 ◽  
Author(s):  
Milovan Dimitrijevic ◽  
Snezana Jesic ◽  
Aleksandar Krstic ◽  
Goran Bjelogrlic ◽  
Goran Stojkovic
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Surgical Approach ◽  
Parapharyngeal Space ◽  
Transoral Approach ◽  
Diagnostic Methods ◽  
Resonance Imaging ◽  
Parapharyngeal Space Tumors ◽  
Adjacent Structures

Introduction: Parapharyngeal space tumors are very rare comprising 0,5% of head and neck tumors. Tumors of this region are significant diagnostic problem due to scanty symptomatology as well as considerable surgical issue owing to inaccessibility. Patients and Methods: Retrospective twenty-year study of patients with parapharyngeal space tumors included 69 patients. Data were obtained from medical records, and were pointed to diagnostic procedures, surgical approach and pathohistological findings. Symptoms and clinical signs were also investigated. Results: Preoperative diagnostics is very important for precise tumor localization and relation to adjacent structures. Computerized tomography was the most common method used, and recently, magnetic resonance imaging and indication-based contrast angiography have been applied. All of 69 patients with parapharyngeal space tumors were treated surgically. The most often approach to this tumor was transcervical (62%), then transoral approach and combination transcervical transoral approach. Pathohistological examination verified that most of the tumors were benign (75%) and origin of these tumors was most frequently salivary (42%). Conclusion: For making a decision on surgical approach, diagnostic methods, other than thorough examination, such as computerized tomography(CT) and/or magnetic resonance imaging (MR), are necessary to be applied.

Tumors of the Parapharyngeal Space Preoperative Evaluation, Diagnosis and Surgical Approaches

1981 ◽  
Vol 90 (1_suppl3) ◽  
pp. 3-15 ◽  
Author(s):  
Peter M. Som ◽  
Hugh F. Biller ◽  
William Lawson
Keyword(s):  
Surgical Approach ◽  
Parapharyngeal Space ◽  
Preoperative Evaluation ◽  
Surgical Approaches ◽  
Tumor Excision ◽  
Parapharyngeal Space Tumor

This report demonstrates that preoperatively the radiologist can provide the surgeon with the size, extent, origin and probable histology of a parapharyngeal space tumor. Using this information, the surgeon can then determine the best surgical approach for complete and safe tumor excision.

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

2021 ◽  
Author(s):  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
María Belen Vega ◽  
Vanessa Hernández-Hernández ◽  
Erik W. Wang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Parapharyngeal Space ◽  
Jugular Bulb ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
The Novel ◽  
Main Trunk ◽  
Transcervical Approach ◽  
Semiquantitative Evaluation ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

Revising the Indications of Transtemporal Surgical Approaches in the Modern Endoscopic Era of Skull Base Surgery: A Dying Art

2020 ◽  
Author(s):  
Ravi Sankar Manogaran ◽  
Raj Kumar ◽  
Arulalan Mathialagan ◽  
Anant Mehrotra ◽  
Amit Keshri ◽  
...  
Keyword(s):  
Skull Base ◽  
Surgical Approach ◽  
Nerve Palsy ◽  
Tertiary Care ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Complete Excision ◽  
Lateral Skull Base ◽  
The Individual ◽  
Selection Of

Abstract Objectives The aim of the study is to emphasize and explore the possible transtemporal approaches for spectrum of complicated lateral skull base pathologies. Design Retrospective analysis of complicated lateral skull base pathologies was managed in our institute between January 2017 and December 2019. Setting The study was conducted in a tertiary care referral center. Main Outcome Measures The study focused on the selection of approach based on site and extent of the pathology, the surgical nuances for each approach, and the associated complications. Results A total of 10 different pathologies of the lateral skull base were managed by different transtemporal approaches. The most common complication encountered was facial nerve palsy (43%, n = 6). Other complications included cerebrospinal fluid (CSF) collection (15%, n = 2), cosmetic deformity (24%, n = 4), petrous internal carotid artery injury (7%, n = 1), and hypoglossal nerve palsy (7%, n = 1). The cosmetic deformity included flap necrosis (n = 2) and postoperative bony defects leading to contour defects of the scalp (n = 2). Conclusion Surgical approach should be tailored based on the individual basis, to obtain adequate exposure and complete excision. Selection of appropriate surgical approach should also be based on the training and preference of the operating surgeon. Whenever necessary, combined surgical approaches facilitating full tumor exposure are recommended so that complete tumor excision is feasible. This requires a multidisciplinary team comprising neurosurgeons, neuro-otologist, neuroanesthetist, and plastic surgeons. The surgeon must know precise microsurgical anatomy to preserve the adjacent nerves and vessels, which is necessary for better surgical outcomes.

Cranial Nerve and Hearing Function after Combined-Approach Surgery for Glomus Jugulare Tumors

1996 ◽  
Vol 105 (12) ◽  
pp. 949-954 ◽  
Author(s):  
Mislav Gjuric ◽  
Stephan Rüdiger Wolf ◽  
Malte Erik Wigand ◽  
Manfred Weidenbecher
Keyword(s):  
Tumor Growth ◽  
Cranial Nerve ◽  
Functional Results ◽  
Surgical Approaches ◽  
Tumor Removal ◽  
Transcervical Approach ◽  
Glomus Jugulare ◽  
Cranial Nerve Palsies ◽  
Ablative Surgery ◽  
The Individual

In this retrospective study, oncologic and functional results of 46 patients treated for glomus jugulare tumor are reported. The standard surgical approach was the combined transmastoid-transcervical approach, modified according to the individual tumor growth, and eventually combined with a transtemporal or a suboccipital approach. Complete tumor removal resulted in a cure rate of 90%. New-onset cranial nerve palsies developed in less than 22% of patients. In 54% of cases it was possible to retain middle ear function. From a total of 12 patients with incomplete tumor removal and postoperative irradiation, progressive tumor growth was noted in 4 patients, and was controlled by salvage irradiation or surgery. Radical tumor removal by ablative surgery can be modified by efforts to reduce mutilating resections. In their place, individually tailored and combined multidirectional surgical approaches may allow total tumor removal with lower morbidity.

scholarly journals New Possible Surgical Approaches for the Submammary Adipofascial Flap Based on Its Arterial Supply

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Ehab M. Elzawawy ◽  
Melad N. Kelada ◽  
Ahmed F. Al Karmouty
Keyword(s):  
Breast Implants ◽  
Partial Mastectomy ◽  
Surgical Approaches ◽  
Lateral Part ◽  
Medial Part ◽  
Fat Necrosis ◽  
Adipofascial Flap ◽  
Multiple Origins ◽  
Inferior Portion ◽  
Perforator Vessels

Introduction. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. Materials and Methods. The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. Conclusions. The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.

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