Resection of Parapharyngeal Space Tumors Located in the Prestyloid Compartment: Efficacy of the Cervical Approach

Background: Tumors of the parapharyngeal space (PPS) are rare, accounting for 0.5–1.5% of all head and neck tumors. The anatomy of the PPS is responsible for a wide variety of tumors arising from the PPS. Our series of 10 PPS tumors provides an overview of the clinical course and management of PPS tumors.Methods: This retrospective study included clinical data from patients treated for PPS tumors from 2011 to 2018 at the Stanley medical college hospital, Chennai. Results: After careful analysis of the outcome of the study, we have found out that there was no local recurrence in any patient during the follow-up period. Though few approaches are advised in the literature, In our study transoral approach may be advocated as the first choice for excision of parapharyngeal space tumors, except for malignant tumors and neurogenic tumor. Trans cervical approach is used for malignant and neurogenic tumors, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck.Conclusions: In our study, middle aged male population was most commonly affected. Pleomorphic adenoma is the most common PPS tumor; prestyloid compartment is mostly affected by these tumors. As per the previous studies, trans cervical approach is first choice for excision of parapharyngeal space tumors. In our study, trans oral approach is also a suitable, safe approach for pre styloid non vascular lesions and trancervical approach can be reserved for postsyloid and malignant lesions.

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Primary Parapharyngeal Space Tumors in a Mexican Cancer Center

Otolaryngology ◽

10.1016/j.otohns.2005.01.013 ◽

2005 ◽

Vol 132 (4) ◽

pp. 587-591 ◽

Cited By ~ 39

Author(s):

Kuauhyama Luna-Ortiz ◽

Jaime Esteban Navarrete-Alemán ◽

Martín Granados-García ◽

Angel Herrera-Gómez

Keyword(s):

Parapharyngeal Space ◽

Tumor Resection ◽

Surgical Approaches ◽

Cancer Center ◽

Peripheral Nerve Sheath Tumors ◽

Parapharyngeal Space Tumors ◽

Adjacent Structures ◽

First Choice ◽

Cervical Approach ◽

Mandibular Swing

OBJECTIVE: To describe clinical and demographic characteristics of the parapharyngeal space tumors and assess surgical approaches used to treat them at our institution. METHODS: A retrospective and descriptive study of the parapharyngeal space tumors, excluding paragangliomas, treated from June 1991 to October 2002 in a cancer center. The study population included 21 patients, 8 men and 13 women, average age of 41 years (range, 20 to 70 years). Fine needle biopsy was done in 5 (24%) patients. Computed tomography (CT) was performed in all patients, and only a few required magnetic resonance image (MRI). RESULTS: Surgical approaches included transcervical alone or in combination with parotidectomy, transoral, or transmandibular (mandibular swing) approach. Laminectomy and segmentary approaches were also performed in 1 patient each. Sixteen (76%) patients had benign lesions and 5 (24%) had malignant tumors. Neurogenic tumors represented 57% of all tumors. Mean tumor size was of 6.7 cm (range, 3 to 11 cm). Six (29%) patients received adjuvant radiotherapy. Complications occurred in 6 (29%) patients, 4 (19%) of which were nervous injuries associated with peripheral nerve sheath tumors. Median disease-free follow-up survival was 33 months (range, 2 to 184 months) despite being an heterogeneous group of histologies. CONCLUSION: Parapharyngeal space is a rare location for head and neck tumors. Cervical approach should be the first choice for large tumors; transoral approach is reserved for tumors less than 3 cm. Conversion to mandibular swing approach when the cervical approach is not offering proper exposure for tumor resection is indicated. Preoperative histologic diagnosis is not required. Nevertheless, CT scan should always be performed in order to exclude paragangliomas, distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures.

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