Endoscopic transoral approach to the lateral poststyloid space

Abstract

The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow‐up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.

A comparative study of transcervical, endoscope‐assisted transcervical, and endoscope‐assisted transoral resection of retrostyloid space schwannomas

“…26 An en bloc resection of large tumors (>4 cm) in the PPS is challenging due to the unique anatomical location with limitations of the surrounding bone and tissues. 27 Unlike pleomorphic adenoma, piecemeal resection is feasible for schwannomas with relatively low risk of tumor seeding with intracapsular excision. Thus, although en bloc resection is difficult in some cases, studies have shown that most tumors in the parapharyngeal space can be completely removed.…”

Endoscopic endonasal combined transoral medial approach to the nasopharynx, parapharyngeal space, and jugular foramen

“…The posterior PPS, also known as the carotid artery space, is located below the jugular foramen and behind the Eustachian tube (ET) which includes the ET cartilage, tensor veli palatini muscle, and levator veli palatini muscle. Lesions located in the PPS and jugular foramen areas are extremely challenging to access because of their deep locations 2 . The conventional lateral cervical approach may require the splitting and displacement of the mandible, which may cause significant surgical trauma and postoperative complications 3 .…”

“…Lesions located in the PPS and jugular foramen areas are extremely challenging to access because of their deep locations. 2 The conventional lateral cervical approach may require the splitting and displacement of the mandible, which may cause significant surgical trauma and postoperative complications. 3 The endoscopic endonasal approach also requires that the ET be removed or displaced to avoid obstruction.…”