Transoral and combined transoral-transcervical approach in the surgery of parapharyngeal tumors
Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Faculty Hospital Motol, Charles University, V Uvalu 84, 15006 Prague 5, Czech Republic. Archives of Oto-Rhino-Laryngology
(Impact Factor: 1.55).
09/2009; 267(5):765-72. DOI: 10.1007/s00405-009-1071-z
The goal of parapharyngeal space (PPS) tumor surgery is to obtain adequate visualization to ensure complete removal with preservation of the surrounding nerves and vessels. Different surgical approaches have been described. Transoral approach is the most controversial one due to cited limited exposure, risk of tumor spillage, and possibility of neurovascular injury. We performed retrospective analysis of 26 consecutive patients who had undergone transoral or combined transoral-transcervical resection of PPS tumors from January 1997 to December 2007. Both approaches were safely employed to remove selected PPS tumors. Majority of treated tumors were pleomorphic adenomas (14 minor salivary gland and 7 deep lobe parotid gland tumors). Two cases of malignant salivary gland tumors, 4 nerve sheath tumors and 1 lymphangioma were also excised. Mean tumor size was 6.1 cm (range 2-11 cm). Visualization was felt to be adequate and dissection safe. Radical resection was achieved in 24 cases. Near-total resection was achieved in two cases where otherwise other approach would be suitable but cannot be undertaken because of patient refusal and comorbidities. Patients with malignant tumors had postoperative radiotherapy. Radically treated cases are disease free. One of the near-totally resected tumors needed revision surgery. Neither major complications nor disordered healing were observed. Transoral approach provides access to selected cases of PPS tumors based on preoperative imaging methods and fine-needle aspiration cytology. Risk of non-radical resection is acceptable. It can be combined with external approach to achieve safe resection of some benign tumors which would need transmandibular approach.
Available from: Marta Tagliabue
- "Parapharyngeal space (PPS) tumors represent 0.5% of head and neck neoplasms  . The PPS is described as an inverted pyramid whose base is at the skull base level and apex at the hyoid bone. "
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ABSTRACT: Parapharyngeal space (PPS) tumors are very rare, representing about 0.5% of head and neck neoplasms. An external surgical approach is mainly used. Several recent papers show how transoral robotic surgery (TORS) excision could be a prospective tool to remove mainly benign lesions in PPS; no cases of neurogenic tumors from the retrostyloid space treated with TORS have been reported. We present two cases which underwent TORS for schwannomas from the retrostyloid compartment of the parapharyngeal space. Clinical diagnosis of schwannoma was performed by magnetic resonance imaging (MRI). In the first case a 6 cm neurogenic tumor arose from the vagus nerve and in the second case a 5 cm mass from the sympathetic chain was observed. Both cases were treated successfully by the TORS approach using a new "J"-shaped incision through the mucosa and superior pharyngeal constrictor muscle. Left vocal cord palsy and the Claude Bernard Horner syndrome, respectively, were observed as expected postsurgical sequelae. In case 1 the first bite syndrome developed after three months, while no complications were observed in case 2. Both patients regained a normal swallowing function. TORS seems to be a feasible mini-invasive procedure for benign PPS masses including masses in the poststyloid space.
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ABSTRACT: Rhabdomyomas are rare benign mesenchymal tumors with skeletal muscle differentiation. They are less commonly encountered than are their malignant counterparts, rhabdomyosarcomas. Rhabdomyomas fall into 2 general categories: cardiac and extracardiac types. Extracardiac rhabdomyomas are among the rarest tumors in humans and can be subclassified as fetal, juvenile, and adult types depending on the individual tumor's degree of differentiation by light microscopy. Adult extracardiac rhabdomyoma has a strong predilection for occurrence in the head and neck, mainly in the area of larynx and pharynx. In this article, 2 cases of parapharyngeal rhabdomyoma are reported together with a review of the world literature.
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ABSTRACT: Parapharyngeal space (PPSp) tumours are uncommon and hence the 'generalist expertise' for diagnosis and treatment is limited. Recent improvements in radiology and cytopathology mean the likely diagnosis is more certain and hence the recommended surgical treatment can be more definitive.
A wide spectrum of primary pathologies are reported to involve the PPSp; the majority (80%) are benign neoplasms. Radiological imaging, computed tomography (CT) and MRI, with diagnostic fine needle aspiration cytology (FNAC), have continued to increase preoperative diagnostic accuracy. Thus, it is easier to identify the patients whose external surgery may rarely require a mandibulotomy. Only highly selected cases can be safely excised via a transoral approach.
All tumours of the PPSp require accurate diagnosis, using modern diagnostic imaging and FNAC. Surgery, in most cases, remains the treatment of choice. Many neurogenic tumours and paragangliomas can be observed in elderly patients. The optimum surgical approach for complete excision needs to be selected on an individual basis. Each patient must be adequately informed of the associated morbidity and possible complications, likelihood of cure and the risk of tumour recurrence - short and long term. Most tumours can be excised safely, and with low risk of recurrence and short hospitalization, with a cervical-parotid approach.
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