Trends in the surgical management of parapharyngeal space tumors: A single-center retrospective analysis

Peri-operative complications following endoscopic-assisted transoral resection of parapharyngeal space tumors: retrospective analysis of 100 patients

PURPOSE

A transoral surgical corridor can provide adequate exposure for extirpation of benign tumors arising from the parapharyngeal space (PPS). However, peri-operative complications following a transoral approach to the PPS have not been sufficiently described. This study retrospectively reviewed patients with PPS tumor extirpated via an endoscopic-assisted transoral approach, aiming to evaluate the safety of this approach and summarize the peri-operative complications.

METHODS

One hundred consecutive patients who underwent an endoscopic-assisted transoral resection of PPS benign tumors at a university hospital were enrolled. Indices including intraoperative catastrophic bleeding, cerebral spinal fluid (CSF) leak, post-operative respiratory airway swelling, cranial neural injury, operative field infection, oral suture dehiscence and venous thrombosis, were assessed from the date of surgery to 3 months after the surgery.

RESULTS

Tumors in the PPS were safely and successfully removed via an endoscopic-assisted transoral approach for all 100 patients. Intra-operative CSF leak occurred in 3 patients, while the CSF leak was appropriately repaired intraoperatively without long-term post-operative CSF leak. No catastrophic bleeding, respiratory airway swelling, and operative field infection occurred. Cranial neuropathy occurred in 16 patients, five of whom fully recovered, while the remainder demonstrated permanent neural deficits. Oral suture dehiscence occurred in 13 patients, and all patients healed well after wound packing. Deep vein thrombosis was observed in three patients and pulmonary embolism in one patient, however, no severe consequences happened.

CONCLUSION

An endoscopic-assisted transoral corridor is safe and effective for benign tumor extirpation in the PPS with few peri-operative complications.

Parapharyngeal space metastasis from squamous cell carcinoma: indications and limits of different surgical approaches

PURPOSE OF REVIEW

The aim of this review is to investigate the most suitable surgical approach to managing parapharyngeal space (PPS) squamous cell carcinoma (SCC) metastasis.

RECENT FINDINGS

SCC metastasis in PPS are extremely rare. The PPS itself is a complex anatomical area, requiring extensive surgical experience and various surgical approaches for effective management. Several authors have attempted to systematize the surgical approaches to the PPS based on the anatomical location and histological nature of the lesions. However, there are currently few studies in the literature on the specific management of SCC metastases in the PPS, as these lesions are extremely rare.

SUMMARY

The treatment of SCC metastases in the PPS must be determined based on the individual patient. If the patient is a candidate for surgery, the surgical approach should be chosen based on the location of the metastases and must ensure a sufficiently wide surgical corridor to allow for as complete a resection as possible. To date, the surgical approach that best meets these requirements is the transcervical transparotid approach. With new technologies, including the use of robotics and endoscopy, surgery can become increasingly less invasive while maintaining the wide exposure provided by open surgical procedures.

A rare case of bronchogenic cyst in the parapharyngeal space

Ectopic bronchogenic cyst arising from the parapharyngeal space is extremely rare and has only been reported once in a case report written in Chinese. Here, we reported one case with such a rare congenital abnormality. The patient accidentally found a mass in the parapharyngeal space when taking the head MRI scan. The CT scan showed a 2.6 × 1.9 cm low-density nodule with a well-defined border. The pathological exam confirmed its diagnosis of parapharyngeal bronchogenic cyst.