Surgical treatment results of parapharyngeal space tumors: a report of 22 cases.

Introduction: Parapharyngeal space (PPS) is the anatomical area lateral to the upper pharynx and clinically important due to PPS tumors. They account for less than 1% of head and neck neoplasms. Both benign and malignant neoplasms may arise there and typical for this localization is diversity of histological origin. Complete surgical excision is still the basis of treatment. Aim of the study: Evaluation of the results of surgical treatment of PPS tumors in the Department of Otolaryngology at the Medical University over the period 2015-2017. Material and methods: A retrospective analysis of medical records including complaints, physical examination, results of imaging studies, surgical approach, postoperative complication and histopathological results in 22 patients with a diagnosis of a PPS tumors. Results: The most frequent complaints reported by the patients were: discomfort in the throat, dysphagia, hearing disorders and a palpable tumor on the neck. Asymptomatic course of the disease was demonstrated in 4 cases. All patients were treated surgically: 2 with transoral approach, 9 with transparotid-transcervical approach, 11 with transcervical approach. In most cases the tumor was removed radically. In 2 patients intracapsular tumor resection was performed. Based on histopathological examination the benign lesions dominated (18/22). In 4 cases malignant neoplasms were diagnosed: carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and two cases of squamous cell carcinoma. The most common origin of PPS tumors was deep lobe of parotid gland and for this group 11 patients had diagnosis of pleomorphic adenoma. Other diagnosis included: paraganglioma, neurofibroma, hemangioma, lymphangioma and rhabdomyoma. Postoperative complications occurred in 9 patients and presented as hoarseness and dysphagia due to paresis of the lower group of cranial nerves (IX, X, XII). Significant intraoperative bleeding during surgery occurred in 2 cases and ligation of the external carotid artery was necessary. Conclusion: Due to the anatomical topography of PPS and its content with the essential vessels and the lower group of cranial nerves, the surgical treatment of pathology of this area is still a challenge for head and neck surgeons. The decrease of voice quality and impaired speech and swallowing should always be considered as complications post the surgical resection in PPS.

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Giant Parotid Pleomorphic Adenoma Involving Parapharyngeal Space

Jurnal Kesehatan Andalas ◽

10.25077/jka.v2i3.170 ◽

2013 ◽

Vol 2 (3) ◽

pp. 189

Author(s):

Sukri Rahman ◽

Bestari J Budiman ◽

Yurni Yurni

Keyword(s):

Salivary Gland ◽

Pleomorphic Adenoma ◽

Parapharyngeal Space ◽

Traumatic Injury ◽

Cranial Nerves ◽

Salivary Gland Tumor ◽

Needle Aspiration ◽

External Carotid Artery ◽

External Carotid ◽

Gland Tumor

AbstrakLatar belakang: Pleomorfik adenoma parotis merupakan tumor jinak kelenjar liur yang paling sering ditemukan, namun pleomorfik adenoma parotis yang sangat besar sehingga melibatkan ruang parafaring (RPF) sangat jarang. Diagnosis ini sulit ditegakkan karena gejala klinisnya tidak khas. Penatalaksanaanya harus hati-hati mengingat banyak struktur vital yang beresiko mengalami trauma. Tujuan: Bagaimana menegakkan diagnosis dan penatalaksanaan pleomorfik adenoma parotis yang melibatkan RPF. Kasus: Seorang pasien perempuan 27 tahun ditegakkan diagnosis pleomorfik adenoma parotis kanan dengan melibatkan RPF. Terdapat pembengkakan pada leher yang bersifat asimtomatis dan gejala pendorongan faring dan laring yang menyebabkan disfonia, disfagia, dan defisit saraf kranial IX,X,XII. Penatalaksanaan: Pasien telah dilakukan operasi parotidektomi pendekatan transervikal–transparotid dengan preservasi arteri karotis eksterna dan saraf fasialis. Kesimpulan: Biopsi Aspirasi Jarum Halus (BAJAH) dan radiologi merupakan pemeriksaan yang penting untuk menegakkan diagnosis. Penatalaksanaan pleomorfik adenoma parotis yang melibatkan RPF adalah bedah ekstirpasi komplit dengan beberapa pendekatan. .Kata kunci: tumor jinak kelenjar liur, pleomorfik adenoma, ruang parafaringAbstractBackground: Parotid pleomorphic adenoma is the most common benign salivary gland tumor, while giant parotid pleomorphic adenoma involving the parapharyngeal space (PPS) is rare. It was difficult to diagnose because the clinical presentation of this tumor can be subtle. The management must be performed carefully due to anatomy relation to complex vital structure lead to traumatic injury highrisk. Purposes: How to make diagnosis and management parotid pleomorphic adenoma involving PPS. Case: A female 27 years old with diagnosis was giant parotid pleomorphic adenoma involving PPS. There was asymptomatic swelling of the neck and presence of pushing the pharynx and larynx medially causes dysphonia, dysphagia, and IX,X,XII cranial nerves deficit. Management: The patient has been performed parotidectomy with transcervical-transparotid approaches by preservation of the external carotid artery and facial nerve. Conclusion: Fine Needle Aspiration Biopsy (FNAB) and imaging are essential for diagnostic. The management of parotid pleomorphic adenoma involving PPS is surgical complete extirpation with various approaches.Keywords:benign salivary gland tumor, pleomorphic adenoma, parapharyngeal space

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Ancient schwannoma of the parapharynx causing dysphagia: a rare entity

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13373405385737 ◽

2012 ◽

Vol 94 (7) ◽

pp. e10-e13 ◽

Cited By ~ 5

Author(s):

SI Sayed ◽

P Rane ◽

A Deshmukh ◽

D Chaukar ◽

S Menon ◽

...

Keyword(s):

Head And Neck ◽

Schwann Cells ◽

Parapharyngeal Space ◽

Rare Entity ◽

Common Site ◽

First Report ◽

Transcervical Approach ◽

Histological Types ◽

Prominent Symptom ◽

Neural Sheath

A schwannoma is a benign, encapsulated tumour that is derived from neural sheath (Schwann) cells. Approximately 25–40% of schwannomas occur in the head and neck. The most common site is the parapharyngeal space of the neck; oropharyngeal occurrence is extremely rare. Among the various histological types of schwannomas reported to date, the ancient (degenerative) variant is the most rare. To our knowledge, this is the first report of an ancient schwannoma in the parapharynx with an extensive oropharyngeal component causing dysphagia. Dysphagia was the prominent symptom because of the location and volume of the lesion. The tumour was excised via a transcervical approach.

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Intracapsular Carcinoma Ex-Pleomorphic Adenoma of the Parapharyngeal Space: Report of Two Cases and Review of the Literature

Tumori Journal ◽

10.5301/tj.5000688 ◽

2017 ◽

Vol 103 (1_suppl) ◽

pp. S73-S77

Author(s):

Remo Accorona ◽

Diego Barbieri ◽

Davide Farina ◽

Davide Lombardi ◽

Mario Bussi ◽

...

Keyword(s):

Pleomorphic Adenoma ◽

Adjuvant Radiotherapy ◽

Parapharyngeal Space ◽

Correct Diagnosis ◽

Needle Aspiration ◽

Malignant Degeneration ◽

Carcinoma Ex Pleomorphic Adenoma ◽

Transcervical Approach ◽

Needle Aspiration Cytology ◽

Clinical Records

Background Carcinoma ex-pleomorphic adenoma of the parapharyngeal space is an exceedingly rare entity. Methods The clinical records of two patients with primary carcinoma ex-pleomorphic adenoma of the parapharyngeal space surgically treated at two different centers were retrospectively analyzed. Results Despite ultrasound-guided fine-needle aspiration cytology and magnetic resonance imaging, the correct diagnosis was preoperatively missed in both cases. Excision was obtained through a transcervical-transparotid approach in 1 case and a minimally-invasive endoscopic-assisted transcervical approach in the other. Definitive histology was consistent with intracapsular carcinoma ex-pleomorphic adenoma. Adjuvant radiotherapy was performed in the case with macroscopic malignant degeneration; both patients are alive and free from disease 36 months after surgery. Conclusions Carcinoma ex-pleomorphic adenoma of the parapharyngeal space is a rare disease, and definitive diagnosis may be challenging. Surgery is the mainstay of treatment, but adjuvant radiotherapy also may be required in the presence of specific risk factors.

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Management of the Facial Nerve in Lateral Skull Base Surgery Analytic Retrospective study

Clinical Medicine Insights Ear Nose and Throat ◽

10.4137/cment.s6570 ◽

2011 ◽

Vol 4 ◽

pp. CMENT.S6570 ◽

Cited By ~ 1

Author(s):

Mohamed A. El Shazly ◽

Mahmoud A.M. Mokbel ◽

Amr A. Elbadry ◽

Hatem S. Badran

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Tumor Resection ◽

Cranial Nerves ◽

Jugular Foramen ◽

External Carotid ◽

Vascular Tumors ◽

Complete Cure ◽

Glomus Jugulare ◽

Lateral Skull Base

Background Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative ligation of the external carotid artery have decreased the intraoperative blood loss. Accurate identification and exposure of the cranial nerves extracranially allows for their preservation during tumor resection. The modification of facial nerve mobilization provides widened infratemporal exposure with less postoperative facial weakness. The ideal approach should enable complete, one stage tumor resection with excellent infratemporal and posterior fossa exposure and would not aggravate or cause neurologic deficit. The aim of this study is to present our experience in handling jugular foramen lesions (mainly glomus jugulare) without the need for anterior facial nerve transposition. Methods In this series we present our experience in Kasr ElEini University hospital (Cairo–-Egypt) in handling 36 patients with jugular foramen lesions over a period of 20 years where the previously mentioned preoperative and operative rules were followed. The clinical status, operative technique and postoperative care and outcome are detailed and analyzed in relation to the outcome. Results Complete cure without complications was achieved in four cases of congenital cholesteatoma and four cases with class B glomus. In advanced cases of glomus jugulare (28 patients) (C and D stages) complete cure was achieved in 21 of them (75%). The operative complications were also related to this group of 28 patients, in the form of facial paralysis in 20 of them (55.6%) and symptomatic vagal paralysis in 18 of them (50%). Conclusions Total anterior rerouting of the facial nerve carries a high risk of facial paralysis. So it should be reserved for cases where the lesion extends beyond the vertical ICA. Otherwise, for less extensive lesions and less aggressive pathologies, less aggressive approaches could be adopted with less hazards.

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Anatomy of the Head and Neck

Oxford Assess and Progress: Clinical Dentistry ◽

10.1093/oso/9780198825173.003.0012 ◽

2019 ◽

Author(s):

Nicholas Longridge ◽

Pete Clarke ◽

Raheel Aftab ◽

Tariq Ali

Keyword(s):

Oral Cavity ◽

Head And Neck ◽

Dental Care ◽

Cranial Nerves ◽

Vascular Supply ◽

External Carotid Artery ◽

External Carotid ◽

Tooth Formation ◽

Fundamental Building Block ◽

Dental Procedures

Both are routine questions encountered by students during their time in dental school, and both require sound knowledge of the anatomy of the head and neck. From wrestling with basic anatomical concepts and planes to tracing the branches of the external carotid artery, anatomy will underpin the rest of your practising career and is a fundamental building block on which all other knowledge can be laid down. Basic anatomical knowledge begins with the osseous structures of the head and neck, blood vessels, lymphatics, and nerves. Interpretation of this knowledge is required for functional and clinical applications, which is a daily occurrence for practising dentists and dental care professionals. Such a large subject is difficult to assess in a small number of questions, but this chapter touches on aspects of developmental embryology and tooth formation, along with functional anatomical questions designed to test the theory behind some common dental procedures and clinical presentations. Undoubtedly, excellent knowledge of the innervation and blood supply to the teeth and surrounding structures will be most beneficial for dentists and dental care professionals during their practising careers. Key topics include: ● Anatomical planes and terminology ● Craniofacial development ● The musculoskeletal system, including ossification and bony remodelling ● Innervation and vascular supply to the head and oral cavity, including the cranial nerves ● Structure of the eye, ear, nasal cavity, and oral cavity ● Odontogenesis ● Histology of the oral cavity.

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Primary Pleomorphic Adenoma of Minor Salivary Gland in the Parapharyngeal Space

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1249 ◽

2016 ◽

Vol 8 (3) ◽

pp. 125-127

Author(s):

Ankita Joshi ◽

Chinmaya Sundar Ray

Keyword(s):

Salivary Gland ◽

Head And Neck ◽

Pleomorphic Adenoma ◽

Parapharyngeal Space ◽

Minor Salivary Gland ◽

Rare Occurrence ◽

Normal Tissues ◽

Neck Tumors ◽

Minor Salivary Gland Tumors ◽

High Index Of Suspicion

ABSTRACT Parapharyngeal space (PPS) lesions account for only 0.5% head and neck tumors and the majority of the minor salivary gland tumors are malignant. We report a case of pleomorphic adenoma of minor salivary gland in PPS as this is of a very rare occurrence. High index of suspicion and an adequate clearance of the tumor with a cuff of surrounding dispensable normal tissues are the key to successful treatment of such tumors. How to cite this article Ray CS, Joshi A. Primary Pleomorphic Adenoma of Minor Salivary Gland in the Parapharyngeal Space. Int J Otorhinolaryngol Clin 2016;8(3):125-127.

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Parapharyngeal Schawannnoma. Case Report

Revista de la Facultad de Medicina Humana ◽

10.25176/rfmh.v21i4.3985 ◽

2021 ◽

Vol 21 (4) ◽

pp. 874-880

Author(s):

Enrique Moyano Navarro ◽

Manuel Inostroza Fernández ◽

Pedro P. Sotelo Jiménez ◽

Ethel Vargas Carrillo ◽

Alan La Torre Zúñiga ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Head And Neck ◽

Female Patient ◽

Parapharyngeal Space ◽

Incisional Biopsy ◽

Neck Tumors ◽

Low Incidence ◽

Parapharyngeal Tumor ◽

Slow Growing

Parapharyngeal tumor lesions present a low incidence, representing between 0,5 and 0,8% of all head and neck tumors. Approximately 80% show benign behavior. The uniqueness of these lesions derives from their complex anatomical situation and the symptoms with which they usually appear, being in most cases nonspecific and almost always derived from the compressive effect produced by the lesion on the oropharynx and the oropharynx. Schwannomas of the parapharyngeal space are very rare tumors that originate from the sheath of schawnn, generally slow growing, and are usually asymptomatic. Treatment is surgical, often complex due to the anatomical location.The case of a 42-year-old female patient with a diagnosis of Schwannoma in the left parapharyngeal region, demonstrated by incisional biopsy, is presented; undergoing surgical treatment, which was carried out without complications.

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Pleomorphic adenoma of head and neck region: our institutional review

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194921 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1522

Author(s):

Gurbax Singh ◽

Sumit Prinja ◽

Aarushi .

Keyword(s):

Salivary Gland ◽

Head And Neck ◽

Pleomorphic Adenoma ◽

Parapharyngeal Space ◽

Neck Region ◽

Preoperative Imaging ◽

Major Salivary Gland ◽

Head And Neck Region ◽

Base Of Tongue

Background: Pleomorphic adenoma is the commonest benign salivary gland neoplasm but it has the tendency to reoccur if not properly removed and has ability to undergo malignant transformation. The aim of the study was to discuss the presentation and treatment of pleomorphic adenoma of the head and neck region.Methods: Retrospective chart review of patients treated for pleomorphic adenoma of the head and neck region between 2011 and 2018. Data assessed included demographics, clinical presentation, imaging, treatment, complications, recurrence and follow‐up. Results: Seventy nine patients with pleomorphic adenoma were identified. Major salivary gland lesions were most common (n=64, 81.0%); 67% (53 of 64) arising in the parotid and 14% (11 of 64) in the submandibular glands. Minor salivary gland lesions were removed from the palate (8 of 15, 53.3%), parapharyngeal space (3 of 15, 20%), nasal septum (2 of 15, 13.3%), lower lip (1 of 15, 6.7%) and base of tongue (1 of 15, 6.7%). Preoperative imaging done was mainly computed tomography in all the cases however in parapharyngeal space cases magnetic resonance imaging was also done. Surgical excision was performed in all patients except base of tongue case.Conclusions: Treatment of pleomorphic adenoma is mainly surgical with negative margin. Rate of recurrence is low, however long follow-up is recommended.

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Intra-arterial chemotherapy with docetaxel and cysplatin in combined treatment of patients with locally advanced squamouse cell head and neck cancer (SCHNC)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.15528 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 15528-15528

Author(s):

G. Adilbayev ◽

D. Adilbay ◽

G. Kim ◽

D. Ahmetov

Keyword(s):

Head And Neck Cancer ◽

Surgical Treatment ◽

Head And Neck ◽

Neck Cancer ◽

Combined Therapy ◽

Locally Advanced ◽

External Carotid ◽

Hematologic Toxicity ◽

Main Role ◽

Number Of Patients

15528 Background: Currently the main role in chemotherapy of head and neck cancer from the 90ths is related to taxans. To elevate the effect of combination docetaxel + cysplatin and to reduce their toxic influence to the organism we have studied intra-arterial path of delivery at the combined therapy of head and neck cancer. Methods: We treated 53 patients with locally advanced SCHNC(T3, T4). All patients received 2 courses of intra-arterial chemotherapy by catheterization the feeding arteries of tumor through the external carotid artery: docetaxel-80 mg/m2, cysplatin-100 mg/m2. Further, depending on the results of chemotherapy, there were performed radiotherapy and surgical treatment in necessary volumes. Results: By analyzing the effect of docetaxel + cysplatin combination in different tumor localizations, we have concluded that the best results have been achieved in oral cavity cancer: 9 (29.1%) patients with CR and 16 (51.6%) patients with PR. Worst results have been achieved in maxilla cancer: 0 CR and 14 PR (63.6%). Hematologic toxicity of chemotherapy has manifested only in 18.8% patients (I, II grade). Non-hemathologic toxicity: alopecia 67.9%; periphery neuropathy 11.3; mucositis 5.3%. Performing radiotherapy as the second stage after chemotherapy has increased the number of patients with CR, in patients with oral cancer up to 45.1% and with maxilla cancer up to 18.1%. All results has been confirmed by cytomorphology. As of now surgical treatment has been performed for 30 patients (56.6%). 86.8% patients have been followed up for 6 to 30 months. Conclusion: This neoadjuvant intra-arterial chemotherapy with docetaxel + cysplatin allows both increasing the results of combined therapy and reducing the toxicity of chemotherapy. No significant financial relationships to disclose.

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Heavily calcified parapharyngeal space mesenchymal chondrosarcoma: Imaging and pathological findings and a review of the literature

The Neuroradiology Journal ◽

10.1177/1971400920962821 ◽

2020 ◽

pp. 197140092096282

Author(s):

Omid Shafaat ◽

Philip R Chapman ◽

Alireza Zandifar ◽

Ehsan Sotoudeh ◽

Erin M Baumgartner ◽

...

Keyword(s):

Head And Neck ◽

Pleomorphic Adenoma ◽

Current Literature ◽

Parapharyngeal Space ◽

Unusual Presentation ◽

Mesenchymal Chondrosarcoma ◽

Pathological Findings ◽

Review Of The Literature ◽

Pathologic Findings

Parapharyngeal space (PPS) masses are relatively rare lesions of the head and neck, and account for 0.5–1.5% of head and neck lesions. The most common lesion to occur in the PPS is a benign salivary neoplasm, typically pleomorphic adenoma either from the deep parotid or from ectopic parotid tissue rests within the PPS. A calcified or ossified mass in this location is exceedingly rare, but a calcified variant of pleomorphic adenoma has been reported. In this study, we present a patient with a heavily calcified PPS mesenchymal chondrosarcoma with an unusual presentation. We discuss the imaging and pathologic findings followed by a review of the current literature.

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