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Barry B, Verillaud B, Jegoux F, Pham Dang N, Baujat B, Chabrillac E, Vergez S, Fakhry N. Surgery of major salivary gland cancers: REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:153-160. [PMID: 38040591 DOI: 10.1016/j.anorl.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To determine the role of surgery of the primary tumor site in the management of primary major salivary gland cancer. MATERIAL AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group, which drafted a non-systematic narrative review of the literature published on Medline, and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS Treatment of salivary gland tumor is mainly surgical. The gold standard for parotid cancer is a total parotidectomy, to obtain clear margins and remove all intraparotid lymph nodes. For low-grade tumors, partial parotidectomy with wide excision of the tumor is acceptable in the case of postoperative diagnosis on definitive histology. In the event of positive margins on definitive analysis, revision surgery should be assessed for feasibility, and performed if possible. CONCLUSION Treatment of primary major salivary gland cancer is based on surgery with clear resection margins, as far away as possible from the tumor. The type of surgery depends on tumor location, pathologic type and extension.
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Affiliation(s)
- B Barry
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital Bichat, AP-HP, Paris, France
| | - B Verillaud
- Département d'ORL et de Chirurgie Cervico-Faciale, Inserm U1141, Hôpital Lariboisière, AP-HP, Université Paris Cité, Paris, France
| | - F Jegoux
- Département d'ORL et Chirurgie Cervico-Faciale, CHU de Rennes, Rennes, France
| | - N Pham Dang
- Service de Chirurgie Maxillo-Faciale, Inserm, Neuro-Dol, Université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - B Baujat
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - E Chabrillac
- Département de Chirurgie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - S Vergez
- Département de Chirurgie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France; Département de Chirurgie ORL et Cervico-Faciale, CHU Toulouse-Larrey, Université Toulouse III Paul-Sabatier, Toulouse, France
| | - N Fakhry
- Service d'ORL et Chirurgie Cervico-Faciale, Hôpital La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France.
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Galli A, Giordano L, Mattioli F, Serafini E, Fermi M, Bramati C, Bussi M. The transcervical-transparotid corridor for management of parapharyngeal space neoplasms: strengths and limits in a bi-institutional retrospective series. Eur Arch Otorhinolaryngol 2024; 281:897-906. [PMID: 37768370 DOI: 10.1007/s00405-023-08256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND PURPOSE Parapharyngeal space (PPS) neoplasms represent 1% of all head and neck tumors and are mostly benign. Surgery is the mainstay of treatment and the transcervical-transparotid (TC-TP) corridor still represents the workhorse for adequate PPS exposure. Our series investigates strengths and limits of this approach on a multi-institutional basis. METHODS We reviewed consecutive patients submitted to PPS surgery via TC-TP route between 2010 and 2020. Hospital stay, early and long-term complications, and disease status were assessed. RESULTS One hundred and twenty nine patients were enrolled. Most tumors were benign (79.8%) and involved the prestyloid space (83.7%); the median largest diameter was 4.0 cm. The TC-TP corridor was used in 70.5% of patients, while a pure TC route in about a quarter of cases. Early postoperative VII CN palsy was evident in 32.3% of patients, while X CN deficit in 9.4%. The long-term morbidity rate was 34.1%, with persistent CN impairment detectable in 26.4% of patients: carotid space location, lesion diameter and malignant histology were the main independent predictors of morbidity. A recurrence occurred in 12 patients (9.4%). CONCLUSIONS The TC-TP corridor represents the benchmark for surgical management of most of PPS neoplasms, though substantial morbidity can still be expected.
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Affiliation(s)
- Andrea Galli
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Leone Giordano
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Mattioli
- Dept. of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Edoardo Serafini
- Dept. of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Matteo Fermi
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Via Giuseppe Massarenti, 9, 40138, Bologna, Italy
| | - Chiara Bramati
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Mario Bussi
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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3
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Devassy ER, Mustaffa HG, Kulkarni RS, Kontham RK. Parapharyngeal space carcinoma disguised as temporomandibular joint disorder: A clinical report. J Prosthet Dent 2023:S0022-3913(23)00477-8. [PMID: 37673780 DOI: 10.1016/j.prosdent.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 09/08/2023]
Abstract
Parapharyngeal space neoplasms tend to have a considerable volume by the time of diagnosis because of their deep location in the neck and may have a relatively long progression before becoming symptomatic. Common presenting signs and symptoms of parapharyngeal space neoplasms include swelling in the neck, intraoral mass, dysphagia, dysphonia, heaviness in the ear, otalgia, and rarely, trismus. Some of these signs and symptoms could be mistaken for signs of temporomandibular disorder (TMD). This clinical report presents the incidental discovery of parapharyngeal space carcinoma initially presenting as TMD. A thorough clinical examination of the temporomandibular joints, supported by their magnetic resonance imaging, led to early detection of the neoplasm, thereby improving the patient's post-treatment survival probability.
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Affiliation(s)
- Elna R Devassy
- Postgraduate student, Department of Prosthodontics, Nair Hospital Dental College, Mumbai, India
| | - Hazari G Mustaffa
- Associate Professor, Department of Prosthodontics, Nair Hospital Dental College, Mumbai, India
| | - Rahul S Kulkarni
- Associate Professor, Department of Prosthodontics, Nair Hospital Dental College, Mumbai, India.
| | - Rakeshkumar K Kontham
- Associate Professor, Department of Orthodontics, Nair Hospital Dental College, Mumbai, India
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Psychogios GV, Michali MC, Litsou EV, Komnos ID, Basiari LV. Resection of Primary and Recurrent Parapharyngeal Space Pleomorphic Adenomas via a Combined Transcervical-Transparotid Approach: A Case Series. Cureus 2023; 15:e39700. [PMID: 37398798 PMCID: PMC10309018 DOI: 10.7759/cureus.39700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Primary parapharyngeal space tumors are rare, and due to the complex anatomy of the parapharyngeal space, their diagnosis and treatment are challenging. Pleomorphic adenoma is the most common histologic type followed by paragangliomas and neurogenic tumors. They can present as a neck lump or an intraoral submucosal mass with the displacement of the ipsilateral tonsil or might be asymptomatic and discovered incidentally on imaging obtained for other reasons. Magnetic resonance imaging (MRI) with gadolinium is the imaging of choice. Surgery remains the treatment of choice and many approaches have been described. In this study, we present three patients with PPS pleomorphic adenoma (two primary and one recurrent), which were resected successfully with a transcervical-transparotid approach without mandibulotomy. Division of the following anatomical structures: the posterior belly of the digastric muscle, stylomandibular ligament, stylohyoid muscle and ligament, and styloglossus muscle is a very important tip for the surgeons because enables displacement of the mandible providing excellent exposure for complete tumor excision. The only postoperative complication was temporary facial nerve palsy in two patients who fully recovered within two months. The aim of this mini case series is to present our experience, together with some tips and benefits of the transcervical-transparotid approach for the resection of pleomorphic adenomas of the PPS.
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Affiliation(s)
- Georgios V Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Maria C Michali
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Eleni V Litsou
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Ioannis D Komnos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
| | - Lentiona V Basiari
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC
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De Luca P, Atturo F, Tombolini M, Colangeli R, Simone M, De Seta D, de Campora L, Tassone D, Camaioni A. Parapharyngeal space tumors: a twenty-year single-center retrospective analysis on the effectiveness of transcervical and transoral approaches on local control and disease-specific survival. Am J Otolaryngol 2023; 44:103741. [PMID: 36566674 DOI: 10.1016/j.amjoto.2022.103741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/31/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To retrospectively analyzed our twenty-years single-center experience in the treatment of PPS tumors, focusing on the selection of surgical approach and the survival outcome. METHODS Tumors involving the PPS between January 2000 and February 2022 were retrospectively included. The surgical approach was dictated by the localization of the tumor, its dimensions, the relation to anatomic structures and its etiology. RESULTS 34 patients were included in the study. The median age was 50.5 yr, with a gender female prevalence. Most tumors were benign and non recurrent. 20 tumors were treated through lateral approach (transcervical or transcervical-transparotid), 11 through medial approach (transoral), and only 3 tumors were approached by multiple corridors. The 5 years disease free survival (DFS) was 78.8 % (CI 78-79.3 %). CONCLUSIONS In our experience, the transcervical and transoral approaches can be considered the ideal surgical approach to manage tumors of PPS, especially in cases of benign neoplasms.
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Affiliation(s)
- Pietro De Luca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy; Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy.
| | - Francesca Atturo
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Mario Tombolini
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Roberta Colangeli
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Matteo Simone
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Daniele De Seta
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Luca de Campora
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Domenico Tassone
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
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Parapharyngeal Space Tumors: Our Experience. J Pers Med 2023; 13:jpm13020283. [PMID: 36836517 PMCID: PMC9962679 DOI: 10.3390/jpm13020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Para-pharyngeal space (PPS) tumors include an heterogeneous group of neoplasms, accounting for approximatively 0.5-1.5% of all head and neck tumors. Management of these neoplasms requires a careful diagnostic workout and an appropriate surgical approach to obtain good outcomes associated with minimal aesthetic drawbacks. In this study we investigated clinical onset, histologic features, surgical treatment outcomes, peri operative complications and follow up of 98 patients treated for PPS tumors in our Centre between 2002 and 2021. Furthermore, we reviewed our preliminary experience of preoperative embolization of hyper vascular PPS tumors trough SQUID12, an ethylene vinyl alcohol copolymers (EVOH) which exhibits many advantages over other embolic agents, due to its better devascularization rate and lower risk of systemic complications. Our data support the hypothesis that transoral surgery scenario should be significantly revised, as it could represent a valid treatment for tumors located in lower and prestyloyd portion of PPS. Moreover, SQUID12, a novel embolization agent, may be a very promising choice for PPS hyper vascularized tumors, ensuring higher devascularization rate, safer procedures and lower risk of systemic dispersion compared to traditional Contour treatment.
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Jiang C, Wang W, Chen S, Liu Y. Management of Parapharyngeal Space Tumors: Clinical Experience with a Large Sample and Review of the Literature. Curr Oncol 2023; 30:1020-1031. [PMID: 36661727 PMCID: PMC9857702 DOI: 10.3390/curroncol30010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/13/2023] Open
Abstract
Parapharyngeal space (PPS) tumors are rare, and they account for 0.5-1.5% of all head and neck tumors. This study summarized the findings of large-sample clinical studies of PPS tumors and reported the clinical work-up and management of 177 cases of PPS tumors at our center. This retrospective study included patients treated for PPS tumors between 2005 and 2020 at our center. The basic characteristics, symptoms, surgical approach, complications, and recurrence rates were analyzed. A total of 99 male and 78 female patients, with a mean age of 48.3 ± 15.1 years, were enrolled in this study. The most common symptoms were external or intraoral masses (114 patients, 64%). Surgical management leveraging, a cervical approach, was used for 131 cases (74%). The tumors were benign for 92% (160 cases), with pleomorphic adenoma being the most common (88 cases, 50%). Surgical complications were reported for 31 cases (18%); facial and vocal cord paralyses were the most common. Three cases of recurrence were observed during the follow-up. PPS tumors are rare and present with atypical clinical manifestations. The current study, which involved cases in a large single center, demonstrates the importance of surgical interventions for PPS tumors. The use of endoscopic techniques has further expanded the scope of traditional surgical approaches and demonstrated its advantages in selected cases.
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Affiliation(s)
- Chuanya Jiang
- Department of Otorhinolaryngology—Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
- Department of Otorhinolaryngology—Head and Neck Surgery, Wuhu Hospital, East China Normal University, Wuhu 241001, China
| | - Wenqian Wang
- Department of Otorhinolaryngology—Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Shanwen Chen
- Department of Otorhinolaryngology—Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yehai Liu
- Department of Otorhinolaryngology—Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
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Vargas N, Assadsangabi R, Birkeland A, Bewley A, Broadhead K, Morisada M, Ivanovic V. Pre-styloid parapharyngeal space masses-Tumor margins as a predictor of benign versus malignant histology on pre-operative CT or MRI. Neuroradiol J 2022; 35:701-705. [PMID: 35640057 PMCID: PMC9626845 DOI: 10.1177/19714009221089027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Evaluate the frequency of benign versus malignant masses within the prestyloid parapharyngeal space (PPS) and determine if tumor margins on preoperative cross-sectional imaging can predict malignancy status. MATERIALS AND METHODS The electronic health record at UC Davis Medical Center was searched for PPS masses surgically resected between 2015 and 2021. Cases located centrally within the prestyloid PPS with confirmed histologic diagnosis were included and separated into either benign or malignant groups. Margins of the tumors were categorized as "well defined" or "infiltrative" on preoperative cross-sectional imaging. Statistical analysis was performed to evaluate relationships between malignancy status and tumor margins. RESULTS A total of 31 cases met the inclusion criteria. Fourteen separate histologic diagnoses were observed. Benign cases comprised 77% (24/31) and the remaining 23% (7/31) were malignant. Pleomorphic adenoma was the most common overall diagnosis at 48% (15/31). Adenoid cystic carcinoma 6% (2/31) was the most common malignant diagnosis. Well-defined tumor margins were seen in 81% (25/31) of cases. A benign diagnosis was found in 96% (24/25) of the cases with well-defined margins. Infiltrative tumor margins were displayed in 19% (6/31) of cases, all were malignant. The sensitivity and specificity of infiltrative tumor margins for malignancy were 85.7% and 100%, respectively. The negative predictive value of infiltrative margins for malignancy was 96%. CONCLUSION Infiltrative tumor margins on preoperative imaging demonstrate high specificity and negative predictive value for malignant histology in prestyloid PPS masses. Margins should therefore be considered when determining clinical management for newly diagnosed PPS tumors.
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Affiliation(s)
- Nicholas Vargas
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Reza Assadsangabi
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Andrew Birkeland
- Department of Otolaryngology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Arnaud Bewley
- Department of Otolaryngology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Kenneth Broadhead
- Department of Statistics, University of California
Davis, Davis, CA, USA
| | - Megan Morisada
- Department of Otolaryngology, University of California Davis
Medical Center, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Department of Radiology, Section of
Neuroradiology, University of California Davis
Medical Center, Sacramento, CA, USA
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Surgical approaches for pleomorphic adenoma of the parapharyngeal space. J Laryngol Otol 2022:1-8. [PMID: 35920024 DOI: 10.1017/s002221512200175x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE This study aimed to analyse the outcomes of surgery for pleomorphic adenoma of the parapharyngeal space in relation to the surgical approach. METHOD This was a single-centre retrospective data analysis conducted from January 2008 to December 2020 on all patients who underwent operation for pleomorphic adenoma originating from the parapharyngeal space. RESULTS Twenty-one patients with a mean age of 52.6 years were included. The transparotid-transcervical approach was the most common (52.4 per cent, n = 11) surgical approach, followed by transoral robotic surgery (28.6 per cent, n = 6) and conventional transoral surgery (19 per cent, n = 4). Post-operative complications included nine cases of transient partial facial nerve palsy and two cases of Frey's syndrome after the transparotid-transcervical approach and 2 cases of transient trismus and 1 pharyngeal wound dehiscence in the conventional transoral approach group. Complete macroscopic excision was always achieved, and no recurrence occurred during follow up. CONCLUSION These three approaches can provide adequate tumour visualisation, a high rate of clear excisional margins and an acceptable morbidity.
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10
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Zhang G, Zhao X, Sun G, Gao N, Yu P, Chen Z. Transoral Endoscopic Localization of the Parapharyngeal Internal Carotid Artery. Skull Base Surg 2022; 83:317-322. [PMID: 35769805 DOI: 10.1055/s-0040-1722229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
Objectives To define transoral endoscopic surgical landmarks for the parapharyngeal segment of the internal carotid artery (ppICA) using cadaveric dissection. Methods Ten fresh cadaveric heads were dissected to demonstrate the parapharyngeal space anatomy and course of the ppICA as seen in a transoral approach. Anatomical measurements of the distance between the ppICA and bony landmarks were recorded and analyzed. Results The stylohyoid ligament, styloglossus, and stylopharyngeus could be considered to be the safe anterior boundary of the ppICA in the transoral approach; among them, the styloid ligament was the most rigid tissue. Dissection between the stylopharyngeus muscle and superior pharyngeal constrictor muscle provides direct access to the ppICA. At the level of the skull base, the distance from the root of the styloid process to the lateral margin of the external aperture of the carotid canal on the left side and on the right side was 8.57 ± 1.97 and 8.80 ± 1.21 mm, respectively. At the level of the maxillary tuberosity, the distance from the ppICA to the maxillary tuberosity on the left side and on the right side was 31.48 ± 2.24 and 31.01 ± 2.88 mm, respectively. Conclusion The endoscopic-assisted transoral approach can facilitate exposure of the ppICA. The root of the styloid process, styloid ligament, and maxillary tuberosity are critical landmarks in the identification of the ppICA in the transoral approach.
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Affiliation(s)
- Guoliang Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, Republic of China
| | - Xia Zhao
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, Republic of China
| | - Guangbin Sun
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, Republic of China
| | - Nan Gao
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, Republic of China
| | - Pengcheng Yu
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, Republic of China
| | - Zhongchun Chen
- Department of Otorhinolaryngology - Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, Republic of China
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11
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Orlando P, Locatello LG, Gallo O, Leopardi G, Maggiore G. Endoscopy‐assisted transoral approach for parapharyngeal space tumors: Our experience and a systematic review of the literature. World J Otorhinolaryngol Head Neck Surg 2022; 9:79-90. [PMID: 37006749 PMCID: PMC10050965 DOI: 10.1002/wjo2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Several approaches have been described for the excision of parapharyngeal space tumors (PPSTs). Advances in endoscopy gave a further stimulus to the use of the transoral route. Aims We present our experience with the endoscopy-assisted transoral approach (EATA) in this regard and a review of the most recent literature about EATA for PPSTs excision. Materials and Methods We retrospectively analyzed our experience and systematically reviewed the literature about the outcomes of this technique. Results Seven PPSTs were completely excised, with three of them requiring a combined transcervical approach. Only one case of postoperative wound dehiscence was registered, and the mean length of stay was 3.9 days. Final histopathological examination confirmed the results obtained with preoperative fine-needle aspiration biopsy in all cases and no recurrences were apparent after a mean follow-up of 28.1 months. Discussion Magnetic resonance imaging, the modified Mallampati score and the 8 Ts criteria are useful instruments for the choice of the most appropriate surgical approach. Conclusion In light of our experience and following other published series in the literature, we believe that EATA may represent a safe and effective approach for the treatment of the majority of PPSTs.
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Affiliation(s)
- Pietro Orlando
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
| | - Gianluca Leopardi
- Unit of Otorhinolaryngology Azienda USL Toscana Centro, San Giuseppe Hospital Empoli Italy
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12
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Limardo A, Blanco L, Menendez J, García L, Ortega A. The development of a clinical algorithm for the diagnosis of tumours in the parapharyngeal space. A systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:141-150. [DOI: 10.1016/j.otoeng.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/21/2020] [Indexed: 11/24/2022]
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13
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Trans-Oral Robotic Surgery: 14 Cases of Pleomorphic Adenoma of the Parapharyngeal Space. J Craniofac Surg 2022; 33:1587-1590. [PMID: 35089893 DOI: 10.1097/scs.0000000000008477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study has been to describe our experience with pleomorphic adenomas of the parapharyngeal space (PPS) treated with trans-oral robotic surgery (TORS). Tumors arising from the PPS comprise less than 0.5% of all head and neck tumors. Salivary gland tumors account for 40% to 50% of PPS lesions with pleomorphic adenomas representing the most common salivary tumors (80%-90%). Parapharyngeal space tumors cause nonspecific symptoms and may be difficult to diagnose. METHODS In our study a preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging and the results were used to plan the correct surgical approach. RESULTS In all cases we were able to employ TORS, a minimally invasive procedure that allows us to operate in narrow and anatomically complex spaces that we can only reach thanks to the use of well-articulated hand pieces. CONCLUSIONS This report indicates that TORS is a safe surgical procedure for the excision of benign tumors of the PPS in selected cases.
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14
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Reerds STH, Gerdsen M, van den Hoogen FJA, Takes RP, van den Broek GB, Vallen HGGJ, Marres HAM, Honings J. Surgical management of deep lobe parotid tumours with and without involvement of the parapharyngeal space. Int J Oral Maxillofac Surg 2021; 51:762-767. [PMID: 34782202 DOI: 10.1016/j.ijom.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/14/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
The diagnosis and treatment of deep lobe parotid tumours is challenging because of the complex surgical accessibility. There is a lack of studies describing the differences between deep lobe tumours that do and do not occupy the parapharyngeal space (PPS). Patients treated for deep lobe tumours occupying the PPS (PPS group) and not occupying the PPS (non-PPS group) were analysed retrospectively. A total of 227 patients were treated surgically for deep lobe parotid tumours between 1990 and 2019. Sixty patients (26.4%) presented with tumours that involved the PPS (PPS group), while 167 (73.6%) presented with tumours that did not occupy the PPS (non-PPS group). The majority of the PPS group tumours were removed using a transcervical or transcervical-transparotid approach. PPS group tumours were larger (P < 0.001), and tumour spill occurred more frequently in this group (benign tumours: P = 0.002; malignant tumours: P = 0.033). Complication rates did not differ between the PPS and non-PPS groups. A transcervical or transcervical-transparotid approach is the preferred method for the management of deep lobe parotid tumours that occupy the PPS in our practice. Tumour spill occurred more frequently in the PPS group, which is most probably due to the larger tumour size and more complex accessibility.
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Affiliation(s)
- S T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands.
| | - M Gerdsen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - F J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - R P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - G B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - H G G J Vallen
- Department of Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands
| | - H A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - J Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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15
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Li L, London NR, Li S, Chen X, Carrau RL. Endoscopic Transoral Approach for Resection of Basal Cell Adenoma Arising in Parapharyngeal Space. J Neurol Surg B Skull Base 2021; 82:675-681. [PMID: 34745836 DOI: 10.1055/s-0040-1715574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/11/2020] [Indexed: 02/02/2023] Open
Abstract
Objectives The clinical and radiological characteristics of the basal cell adenoma (BCA) and its association with the internal carotid artery (ICA) in the parapharyngeal space (PPS), have not been sufficiently explored. This study aims to analyze the characteristics of patients with BCA arising in the PPS and to evaluate the feasibility of a total resection via an endoscopic transoral corridor. Design and Main Outcome Measures The clinical, radiological, and histopathological characteristics of four patients with BCA arising in the PPS were retrospectively analyzed. The endoscopic transoral approach was performed for resection of BCA. Its technical nuances, perioperative comorbidities, and outcomes are introduced. Results The clinical presentation, symptoms, and signs of patients with BCA are variable. The tumor was lateral to the ICA in two patients and anterior to the ICA in the remaining two. All four BCA were successfully removed en bloc ( n = 3) or by piecemeal ( n = 1) via an endoscopic transoral approach. The ICA was not injured, and no additional nerve damage, venous bleeding, postoperative infection, or salivary gland fistula were encountered in any of the four patients. Cystic degeneration is the predominant appearance of BCA on MRI; however, they are difficult to differentiate from other lesions arising in the PPS. No recurrence was detected at the time of the study analysis. Conclusion BCA of the PPS could have variable relationships with the ICA. An endoscopic transoral approach can provide an adequate corridor for total resection of BCA in PPS with seemingly low morbidity.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Nyall R London
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, United States.,Sinonasal and Skull Base Tumor Program, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland, United States
| | - Shuling Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaohong Chen
- Department of Otolaryngology-Head & Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ricardo L Carrau
- Department of Otolaryngology-Head & Neck Surgery, The James Cancer Hospital at the Wexner Medical Center of The Ohio State University, Columbus, Ohio, United States
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Limardo A, Blanco L, Menendez J, García L, Ortega A. The development of a clinical algorithm for the diagnosis of tumours in the parapharyngeal space. A systematic review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30192-8. [PMID: 33810827 DOI: 10.1016/j.otorri.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Parapharyngeal space (PPS) is defined as a deep space, located around the upper pharynx, in the shape of an inverted pyramid. Primary tumours in this region are rare, accounting for 0.5% of head and neck neoplasms, and most are benign. The objective of this study is to propose a new study algorithm based on a systematic review and our experience. MATERIALS AND METHODS A cross-sectional and analytical study was carried out through review of the clinical records of our hospital. Patients with tumours of the parapharyngeal space operated from January 2010 to December 2019 and a systematic review of Pubmed studies from the last 5years were included. We considered clinical signs, diagnostic methods, presumptive diagnosis and histopathological findings. Statistical analysis was performed with STATA v.14 software. RESULTS 53 of our cases and 1392 from the review were included. The clinical algorithm showed a sensitivity of 76.4% and a specificity of 96.3%, with an AUC of 0.57 for diagnosis. DISCUSSION Complementary radiological examinations are essential in the topographic diagnosis of the tumour. Angio-MRI links the tissue of origin of the tumours and provides the highest diagnostic certainty. FNA has some disadvantages in PPS, but it is useful in some patients. CONCLUSION The proposed algorithm contributes to obtaining excellent results in the management of these tumours because it turned out to be effective in diagnosis, and this enables improved surgical planning.
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Affiliation(s)
- Andrés Limardo
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina.
| | - Luis Blanco
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
| | - José Menendez
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
| | - Laura García
- Sección de Cirugía de Cabeza y Cuello, Hospital Regional Gobernador Ernesto M. Campos, Ushuaia, Tierra del Fuego, Argentina
| | - Adrián Ortega
- Sección de Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Nacional Profesor A. Posadas, El Palomar, Buenos Aires, Argentina
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Feng Y, Wang J, Li X, Meng L, Rao Y, Yang F. The intraoral growth patterns of parapharyngeal tumors: A proposed classification system. EAR, NOSE & THROAT JOURNAL 2021; 102:251-258. [PMID: 33685250 DOI: 10.1177/0145561321997557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Nearly half of parapharyngeal space (PPS) tumors present as an intraoral mass, which is diagnostically challenging. In this study, we studied whether preoperative growth patterns were associated with histopathological diagnosis for planning surgery. METHODS We performed a cross-sectional study in patients with PPS tumors. A simplified classification scheme based on intraoral tumor growth patterns (patterns 1 and 2) was then proposed. In pattern 1, tumors bulge submucosally to the oropharynx from the soft palate, with the center convexity above the uvula. In pattern 2, tumors bulge submucosally to the oropharynx from the lateral oropharynx wall, with the center convexity below the uvula. The association of this classification with postoperative histopathological diagnosis and surgical-related events was studied. RESULTS Twenty-two patients were enrolled in this study (12 with pattern 1, 10 with pattern 2). Of these, 91.7% (11/12) of pattern 1 tumors were salivary gland tumors (P < .001), and 90% (9/10) of pattern 2 tumors were neurogenic (P < .001). Pattern 2 tumors had fewer bleeding complications or needed external approaches when a transoral approach was chosen. CONCLUSIONS This new classification of PPS tumors facilitates the prediction of salivary gland and neurogenic tumors and can improve the accuracy of preoperative radiologic diagnosis. This system will be helpful for planning surgical interventions, such as implementing transoral approaches.
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Affiliation(s)
- Yanjun Feng
- Department of Otolaryngology-Head and Neck Surgery, 12667Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, People's Republic of China
| | - Jianhong Wang
- Department of Otolaryngology-Head and Neck Surgery, 12667Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, People's Republic of China
| | - Xiping Li
- Department of Otolaryngology-Head and Neck Surgery, 12667Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, People's Republic of China
| | - Lingzhao Meng
- Department of Otolaryngology-Head and Neck Surgery, 12667Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, People's Republic of China
| | - Yuansheng Rao
- Department of Otolaryngology-Head and Neck Surgery, 12667Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, People's Republic of China
| | - Fan Yang
- Department of Otolaryngology-Head and Neck Surgery, 12667Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, People's Republic of China
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18
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Infratemporal fossa surgical approaches to primary/recurrent malignancies of salivary origin: paradigm surgical shift, patient selection, and oncologic outcomes. Curr Opin Otolaryngol Head Neck Surg 2020; 28:79-89. [PMID: 32011396 DOI: 10.1097/moo.0000000000000613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW To review, the surgical approaches available on diagnosing a patient with salivary gland malignancy in the infratemporal fossa (ITF). To comment on patient evaluation and method of treatment selection. To identify and report on patient outcome data and make recommendations on future needs. RECENT FINDINGS There is a need to define the anatomic boundaries contents of the ITF, masticator space, parapharyngeal space (PPS), pterygopalatine fossa, ventral skull base, and paramedian skull base, as evidence from publications. The pathological subtypes identified mainly include adenoid cystic and mucoepidermoid carcinomas. The source of these tumours originates from primary disease in the sinonasal tract and nasopharynx superiorly, and the PPS/deep lobe of parotid inferiorly. Current surgical options available, in suitable selected patient, available in tertiary head and neck cancer hospitals, which have available facilities and staffing is the endoscopic endonasal approach. This approach offers patients a 'complete margin-free surgical excision', minimal complications, shorter hospital stay, and no delay with commencement of any adjuvant treatment compared with the traditional 'open transcutaneous' approach. SUMMARY The current evidence specifically to the surgical management of salivary gland malignancy involving the ITF is sparse, with great difficult identifying treated patients and their details among a heterogeneous group of patients with many lesions. There is a need for patient data that have specific pathologic conditions to be amalgamated from such centers and publish on outcome events.
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19
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Shafaat O, Chapman PR, Zandifar A, Sotoudeh E, Baumgartner EM, Sotoudeh H. Heavily calcified parapharyngeal space mesenchymal chondrosarcoma: Imaging and pathological findings and a review of the literature. Neuroradiol J 2020; 34:45-48. [PMID: 32998632 DOI: 10.1177/1971400920962821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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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Affiliation(s)
- Omid Shafaat
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA.,Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Iran
| | - Philip R Chapman
- Division of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, USA
| | - Alireza Zandifar
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Iran.,Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Iran
| | | | | | - Houman Sotoudeh
- Division of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, USA
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20
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Li L, London NR, Gao Y, Carrau RL, Chen X. Endoscopic transoral approach for resection of retrostyloid parapharyngeal space tumors: Retrospective analysis of 16 patients. Head Neck 2020; 42:3531-3537. [DOI: 10.1002/hed.26415] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/16/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Lifeng Li
- Department of Otolaryngology Head and Neck Surgery Beijing Tongren Hospital, Capital Medical University Beijing China
| | - Nyall R. London
- Department of Otolaryngology‐Head & Neck Surgery Johns Hopkins School of Medicine Baltimore Maryland USA
- Sinonasal and Skull Base Tumor Program National Institute on Deafness and Other Communication Disorders, NIH Bethesda Maryland USA
| | - Yanyong Gao
- Department of Otolaryngology Head and Neck Surgery Beijing Tongren Hospital, Capital Medical University Beijing China
| | - Ricardo L. Carrau
- Department of Otolaryngology‐Head & Neck Surgery The James Cancer Hospital at the Wexner Medical Center of The Ohio State University Columbus Ohio USA
| | - Xiaohong Chen
- Department of Otolaryngology Head and Neck Surgery Beijing Tongren Hospital, Capital Medical University Beijing China
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21
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Tumor, host and surgery related factors predisposing to cranial nerve deficits after surgical treatment of parapharyngeal space tumors. Eur Arch Otorhinolaryngol 2020; 278:1973-1981. [PMID: 32778936 PMCID: PMC8131331 DOI: 10.1007/s00405-020-06261-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/30/2020] [Indexed: 12/02/2022]
Abstract
Propose Identification of relevant features acquired on preoperative evaluation of parapharyngeal space (PPS) tumors or related to the performed surgical approach that are predictive of the most important complication of surgical treatment of these tumors, cranial nerve palsy. Methods This was a retrospective analysis of 68 patients with PPS tumors treated with surgical resection in a tertiary referral center from 2009 to 2019. The preoperative clinical symptoms, age, sex, tumor size, location, histopathological type, surgical approach, radical resection, intraoperative bleeding and the occurrence of complications were collected, evaluated and compared. Results Cross-table and chi-square test results revealed that cranial nerve deficits were more common in neurogenic tumors than in other types, including malignant tumors (χ2 = 6.118, p = 0.013); the cervical approach was selected more often for neurogenic tumors (χ2 = 14.134, p < 0.001); neurogenic tumors were more frequently removed intracapsularly (χ2 = 6.424, p = 0.011); and neurogenic tumors were more likely to be located in the poststyloid area (χ2 = 17.464, p < 0.001). The two-sample t test revealed a significant correlation between age and the prevalence of cranial nerve complications (t = 2.242, p = 0.031). The mean age in the group of patients with cranial nerve palsy was 45.89 years, and that of the group without complications was 54.69 years. The results of logistic regression confirmed that the risk of nerve deficits was almost 8 times higher for neurogenic tumors (OR = 7.778, p = 0.01). None of the other analyzed variables related to tumor or surgery was significantly correlated with an increased risk of cranial nerve dysfunction. Conclusion Surgical resection of tumors other than neurogenic tumors of the PPS reveals no significant risk for permanent neural dysfunction. Tumor size also had no significant effect on the risk of postoperative nerve palsy.
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22
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Kimura A, Seino Y, Yamashita T. Transoral endoscopic surgical approach to venous malformation of the parapharyngeal space. SAGE Open Med Case Rep 2020; 8:2050313X20938248. [PMID: 32670582 PMCID: PMC7339072 DOI: 10.1177/2050313x20938248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 06/06/2020] [Indexed: 11/22/2022] Open
Abstract
We encountered a rare case of venous malformation located in the parapharyngeal space.
The 65-year-old female patient did not have any symptoms, and the malformation was
discovered incidentally during a clinical survey. Examination of the oral cavity revealed
a mass in the left soft palate. Magnetic resonance imaging showed a well-defined mass in
the left parapharyngeal space. Fine needle aspiration cytology suggested no malignancy.
Four years after the first visit, she underwent surgery for diagnosis and treatment. We
safely removed the mass with a rigid videoendoscope trans-orally. No postoperative
complications arose, and she was discharged 7 days after the operation. Histopathological
examination identified cavernous hemangioma. Venous malformation (cavernous hemangioma) of
the parapharyngeal space is very rare, and few cases of removal under a transoral approach
using a rigid endoscope with a flexible tip have been reported. This approach is safe and
can be recommended for selected tumors of the parapharyngeal space.
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Affiliation(s)
- Akari Kimura
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yutomo Seino
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Taku Yamashita
- Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Lombardi D, Ferrari M, Paderno A, Taboni S, Rampinelli V, Barbara F, Schreiber A, Mattavelli D, Tomasoni M, Farina D, Ravanelli M, Maroldi R, Nicolai P. Selection of the surgical approach for lesions with parapharyngeal space involvement: A single-center experience on 153 cases. Oral Oncol 2020; 109:104872. [PMID: 32659725 DOI: 10.1016/j.oraloncology.2020.104872] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The parapharyngeal space (PPS) can harbor a variety of tumors that can be approached through a wide spectrum of surgical routes. A decisional algorithm on the surgical approach to resect PPS lesions was tested in terms of reliability by retrospectively applying it to a large series of patients. METHODS Patients treated at the Unit of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, for tumor or tumor-like lesions involving the PPS between October 1986 and July 2019 were included in the retrospective analysis. Tumor characteristics, clinical presentation, diagnostic work-up, type of resection, surgical approach, and oncologic and morbidity outcomes were reviewed. Reliability of the algorithm was calculated as the number of cases in which the expected approach was confirmed/total number of cases × 100. RESULTS The analysis included 153 patients. Most lesions (64.1%) were benign. The most frequent complaint at presentation was unilateral oropharyngeal medialization (47.1%), followed by neck/parotid swelling (41.2%). Ninety-two (61.3%) lesions were excised through an enucleation/extracapsular dissection. Wide-margin resection and compartmental resection were performed in 17 (11.3%) and 41 (27.3%) patients, respectively. A single-corridor approach was employed in 132 (87.4%) cases. Combinations of multiple corridors were adopted in 19 (12.6%) patients. Reliability of the decision-making algorithm was 91.2%. Capsular integrity and margin status affected prognosis of pleomorphic adenomas and PPS malignancies, respectively. CONCLUSION The proposed decision-making algorithm can reliably guide approach selection, which should primarily aim at ensuring intact-capsule excision of benign lesions suspicious for pleomorphic adenomas and clear-margins resection of PPS malignancies.
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Affiliation(s)
- Davide Lombardi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Ferrari
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy; Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Barbara
- Unit of Otolaryngology and Head and Neck, P.O. "Mons. R. Dimiccoli", Barletta, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Davide Farina
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Unit of Radiology, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
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Tsunoda A, Kishimoto S, Tou M, Anzai T, Matsumoto F, Oba S, Ikeda K. Endoscopy-Aided Combined Intraoral and Cervical Approach for a Huge Parapharyngeal Benign Tumor. EAR, NOSE & THROAT JOURNAL 2020; 100:1041S-1044S. [PMID: 32551957 DOI: 10.1177/0145561320935834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We introduce here our surgical approach for the removal of a huge parapharyngeal tumor in 3 cases. Surgery was done under general anesthesia using transnasal intubation. Transoral manipulation was performed first. Using a tongue retractor and an angle widener, a wide surgical field was provided. Incision was made on the palate around the tumor. Tumor was separated from the surrounding tissue, preserving the tumor capsule. Then, a 5-cm small skin incision was made. Both parotid and submandibular glands were pushed upward, and the parapharyngeal space was opened. The tumor was also separated from the surrounding tissue. These manipulations were done under endoscopic observation. Finally, the tumor was pushed laterally and safely removed intraorally. After removal of the tumor, the wounds were closed, and vacuum drainage was settled for a few days. No apparent problems, such as malocclusion and facial palsy, occurred, and the patients were free from disease for more than 10 years. For the removal of a large parapharyngeal tumor, the mandibular swing approach is usually used; however, this approach is invasive, and certain sequelae, such as facial wound and malocclusion, may occur. Our technique enables the safe and less invasive removal of such a huge parapharyngeal benign lesion.
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Affiliation(s)
- Atsunobu Tsunoda
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Seiji Kishimoto
- Department of Otolaryngology, Kameda Medical Center, Kamogawa, Japan
| | - Miri Tou
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takashi Anzai
- Department of Otolaryngology, Juntendo University, Tokyo, Japan
| | | | - Shinichi Oba
- Department of Otolaryngology, Juntendo University, Tokyo, Japan
| | - Katsuhisa Ikeda
- Department of Otolaryngology, Juntendo University, Tokyo, Japan
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26
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The Role of Transoral Robotic Surgery for Parapharyngeal Space: Experience of a Tertiary Center. J Craniofac Surg 2019; 31:117-120. [PMID: 31634316 DOI: 10.1097/scs.0000000000005912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The parapharyngeal space (PPS) is an anatomically and functionally complex region of the craniofacial district. Tumors that originate from this region are rare, and surgery is currently the best practice in the vast majority of cases with different surgical approaches being reported in the literature. Recently, mini-invasive robotic/endoscopic techniques have begun to emerge as effective alternatives in selected cases. In this work, we retrospectively analyzed 17 patients affected by PPS tumors, and managed by transoral robotic surgery (TORS) as a therapeutic or diagnostic procedure. TORS was used alone or combined with a transcervical approach for huge lesions of the PPS, at risk of fragmentation (curative intent). TORS also permitted biopsies of unknown lesions of the PPS to be conducted (diagnostic intent) otherwise unreachable without performing a mandibulotomy. All patients treated with curative intent benefited from radical surgery. No major complications were observed, and tumor fragmentation occurred only in 2 of 17 patients (11.8%). All patients receiving TORS with diagnostic intent were successfully referred to nonsurgical treatments based on the final histhopathological findings. This work also demonstrated TORS to be effective and safe on a larger group of patients compared to our preliminary study in 2016. TORS provides good oncological and functional outcomes when used with curative intent and is an effective diagnostic tool in cases of suspicious lesions of the PPS.
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Abstract
Objective Primary parapharyngeal space (PPS) tumors are one of the most challenging head and neck tumors to diagnose and treat. We analyzed our experience in patients with PPS tumors who were treated in our hospital over 13 years. Methods We retrospectively reviewed 16 patients with PPS tumors between 2006 and 2018. The study included clinical symptoms, histological types, surgical approaches, adjuvant therapies, postoperative complications, and prognosis. Results The mean age of the patients was 49.63 ± 17.03 years. A palpable neck mass (56.3%) was the most common symptom. In our series, 78.6% of the tumors were benign, and of these, schwannomas were the most common (6/14, 42.9%). Three surgical approaches were used in our patients, including transmandibular (57.1%), transcervical (21.4%) and transparotid (21.4%) approaches. Few complications were reported, including hoarseness and numbness. Adjuvant therapy was administered depending on pathological parameters of the tumors. No recurrence was observed during a mean follow-up of 60.6 months in patients with malignant tumors. Conclusions Radiological studies of PPS tumors are essential for diagnosis and surgical planning. Excision of PPS tumors using appropriate surgical approaches provides good outcomes.
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Affiliation(s)
- Kuang-Hsu Lien
- 1 Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,2 School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Kuang Young
- 2 School of Medicine, Chang Gung University, Taoyuan, Taiwan.,3 Department of Otolaryngology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shy-Chyi Chin
- 2 School of Medicine, Chang Gung University, Taoyuan, Taiwan.,4 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Chun-Ta Liao
- 1 Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shiang-Fu Huang
- 1 Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,5 Department of Public Health, Chang Gung University, Taoyuan, Taiwan
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28
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Valls-Ontañón A, Cuscó-Albors S, Marí-Roig A, Masià-Gridilla J, Hernández-Alfaro F. Minimally-invasive resection of benign tumours of the parotid gland in the parapharyngeal space. Br J Oral Maxillofac Surg 2019; 57:808-809. [PMID: 31272845 DOI: 10.1016/j.bjoms.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- A Valls-Ontañón
- Institute of Maxillofacial Surgery, Quirón-Teknon Medical Centre Barcelona, Barcelona, Spain; Oral and Maxillofacial Surgery Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain.
| | - S Cuscó-Albors
- Oral and Maxillofacial Surgery Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - A Marí-Roig
- Oral and Maxillofacial Surgery Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - J Masià-Gridilla
- Institute of Maxillofacial Surgery, Quirón-Teknon Medical Centre Barcelona, Barcelona, Spain
| | - F Hernández-Alfaro
- Institute of Maxillofacial Surgery, Quirón-Teknon Medical Centre Barcelona, Barcelona, Spain
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29
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Surgical Treatment of Primary Parapharyngeal Space Tumors: A Single-Institution Review of 28 Cases. J Oral Maxillofac Surg 2019; 77:1520.e1-1520.e16. [DOI: 10.1016/j.joms.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 11/19/2022]
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30
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Dang S, Shinn JR, Seim N, Netterville JL, Mannion K. Diagnosis and treatment considerations of parapharyngeal space masses – A review with case report. OTOLARYNGOLOGY CASE REPORTS 2019. [DOI: 10.1016/j.xocr.2019.100120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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31
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Mendenhall WM, Strojan P, Beitler JJ, Langendijk JA, Suarez C, Lee AW, Rinaldo A, Rodrigo JP, Smee R, Eisbruch A, Harrison LB, Corry J, Ferlito A. Radiotherapy for parapharyngeal space tumors. Am J Otolaryngol 2019; 40:289-291. [PMID: 30621929 DOI: 10.1016/j.amjoto.2018.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
A wide variety of tumors, both benign and malignant, occur in the parapharyngeal space. Depending on histology and extent, treatment may include surgery and/or radiotherapy (RT). Herein we discuss the role of RT in the management of some of the more commonly encountered neoplasms, including salivary gland tumors, paragangliomas, schwannomas, and soft-tissue sarcomas.
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32
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He H, Yang Q, Gong J, Luo L, Huang T, Chen Z, Guo Y, Li W. Endoscopic Transvestibular Transmandibular Approach for Trigeminal Schwannoma in Infratemporal Fossa and Parapharyngeal Space. World Neurosurg 2018; 118:172-176. [PMID: 30031184 DOI: 10.1016/j.wneu.2018.07.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schwannomas that involve the mandibular division of the trigeminal nerve and localize exclusively in the parapharyngeal space (PPS) and infratemporal fossa (ITF) are extremely rare, and a surgical approach to treat such tumors has not been well established. CASE DESCRIPTION We present our experience in the treatment of a giant trigeminal schwannoma with wide extension in the ITF and PPS using an endoscopic transvestibular transmandibular approach. The clinical and radiologic findings, preoperative planning, advantages of the surgical approach, and clinical outcome are discussed. CONCLUSIONS Schwannomas located in the ITF and PPS are rare benign neoplasms. They are usually detected late after considerable signs and symptoms appear. Preoperative planning is beneficial to individual surgical approach selection. Total surgical excision following careful evaluation of preoperative computed tomography and magnetic resonance images is the treatment of choice. Recurrence is rare after complete excision.
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Affiliation(s)
- Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qintai Yang
- Department of Otolaryngology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Gong
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tengchao Huang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhuopeng Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wensheng Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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33
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Pradhan P, Preetam C, Parida PK, Samal S, Samal DK. Surgical Management of Parapharyngeal Space Tumours in a Single Tertiary Care Center. Indian J Otolaryngol Head Neck Surg 2018; 70:531-537. [PMID: 30464911 DOI: 10.1007/s12070-018-1447-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/04/2018] [Indexed: 12/01/2022] Open
Abstract
Because of the inaccessibility and overcrowding of the vital neurovascular structures, management of the parapharyngeal space (PPS) tumour is always a challenge to the surgeons. Here we have discussed the clinical findings and management of the PPS tumours with special concern to the surgical approaches. It is a retrospective study containing 14 patients of PPS tumour from June 2015 to January 2018 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. 14 consecutive patients with PPS tumours were included in the study. The retrospective clinical data, diagnostic procedures, surgical approaches and the complications were analyzed after 12 months of surgery. Of 14 patients included in the study, 10 patients were males and 4 were females. Prestyloid and poststyloid spaces were involved in 28.57% and 71.42% cases respectively. Transcervical excision of the tumours were performed in 10 patients, 2 patients had undergone transcervical-transoral approach. Transcervical transmandibular and transcervical transparotid excision of tumours were performed in one patient each. Facial nerve injury was detected in 3(21.42%) patients. Injury to the internal carotid artery and wound infection were detected in one patient each. Radiological imaging, especially the MRI helps by narrowing the spectrum of the differential diagnosis distinguishing the benign from malignant lesions, especially in cases where FNAC is contraindicated. Although the transcervical approach is commonly practiced, the combined surgical approach can be effectively applied specially for extensive PPS tumours associated with satisfactory clinical outcomes.
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Affiliation(s)
- Pradeep Pradhan
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Chappity Preetam
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Pradipta Kumar Parida
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Swagatika Samal
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
| | - Dillip Kumar Samal
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019 India
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