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. 2014 Oct;34(5):310-6.

Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases

B Basaran  1 , B Polat  1 , S Unsaler  1 , M Ulusan  1 , I Aslan  1 , G Hafiz  1
Affiliations

Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases

B Basaran et al. Acta Otorhinolaryngol Ital. 2014 Oct.

Abstract
in English, Italian

The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.

Scopo del presente studio è di descrivere la nostra esperienza riguardo i tumori benigni della regione parafaringea sottoposti a resezione chirurgica per via transcervicale senza mandibulotomia e valutarne le complicanze post-operatorie. Questo studio analizza retrospettivamente una serie di 44 pazienti sottoposti ad intervento chirurgico per tumori benigni della regione parafaringea nell'arco temporale di 10 anni. La diagnosi è stata formulata in tutti i pazienti sulla base dei dati clinici e radiologici; in nessun caso è stato utilizzato lo studio citologico su agoaspirato (FNAB). In tutti i casi l'approccio di scelta alla neoformazione è stato quello transcervicale. In 5 pazienti è stato necessario un allargamento alla regione parotidea per via della localizzazione anatomica della lesione. I tumori sono stati classificati radiologicamente in post-stiloidei in 27 casi e in prestiloidei in 17 casi. La diagnosi istopatologica definitiva è risultata in 16 casi di paraganglioma vagale, in 13 casi di adenoma pleomorfo, in 10 casi di schwannoma e di tumori relativamente rari nei rimanenti 5 casi. In tre pazienti è stata osservata paralisi di nervi cranici nel pre-operatorio. Paralisi permanente di nervi cranici è stata osservata in 19 casi (43.2%) nel post-operatorio, nella maggioranza di casi si trattava di tumori neurogenici quali paragangliomi del vago (n:16) e schwannoma (n:2) e in un caso di tumore non-neurogenico della regione parafaringea. Il periodo medio di follow up è stato di 61 mesi (SD +/- 33.10) e in questo lasso di tempo non sono state osservate recidive locali di malattia in nessun paziente. L'approccio per via transcervicale dovrebbe costituire il trattamento chirurgico di prima scelta nei tumori della regione parafaringea eccezion fatta per le forme ricorrenti o maligne. I vantaggi sono legati all'accesso diretto alla regione parafaringea, adeguata esposizione chirurgica delle strutture neurovascolari del collo, miglior risultato estetico associato al mantenimento della continuità della mandibola e ridotte morbidità ed ospedalizzazione.

Keywords: Benign; Mandibulotomy; Parapharyngeal; Transcervical; Tumour.

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Figures

Fig. 1.
Fig. 1.
Haemangiopericytoma of the parapharyngeal space. Note the submandibulary gland is excised, the digastric muscle is transected and its posterior belly is resected (white arrow). A parotidectomy extension is done (white star) and following identification of the facial nerve, its marginal branch is retracted superiorly (black arrow).
Fig. 2.
Fig. 2.
Pleomorphic adenoma of the parapharyngeal space (black star). The submandibulary gland and anterior belly of the digastric muscle is pulled up anteriorly (black arrow). The posterior belly of the digastric muscle is retracted posteriorly (white arrow).
Fig. 3.
Fig. 3.
A case of schwannoma originating from the hypoglossal nerve. The submandibulary gland is pulled anteriorly and the digastric muscle is retracted superiorly. The white arrow shows the hypoglossal nerve.
See this image and copyright information in PMC

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