Parapharyngeal Space Tumor: Submandibular Approach Without Mandibulotomy

Abstract

Introduction Among all head and neck tumors, only 0.5% occur in the parapharyngeal space and 80% are benign tumors. Surgery is the cornerstone of treatment. The deep location of this space and surrounding structures has given rise to a large number of surgical approaches for resection of parapharyngeal neoplasms. Our experience using the submandibular transcervical approach on 14 patients who had surgery upfront for treatment of these lesions is described. Material and methods This is a retrospective, descriptive case-series analysis of patients with parapharyngeal space tumors treated from January 2009 to July 2016, in whom carotid body tumors were excluded. Fourteen patients were included, 11 females (76.9%) and 3 males (23.1%), with a mean age of 46.9 years (SD 14.85). Results The most common symptom reported at patient's presentation to our clinic was a foreign body sensation in the oropharynx and pain. Navigation-guided surgery was used in two cases. Mean tumor size was 4.7 cm (SD 1.785). Complete resection of lesions was performed in all cases, and the major complication was massive bleeding in one case (7.1%). Conclusion According to the present analysis, the submandibular transcervical approach is an effective and safe technique that allows resection of large parapharyngeal tumors, even those close to the skull base. It has minimal complication rate, prevents morbidity associated mandibulotomy and allows extension to a transparotid, transmandibular and even to an infratemporal fossa approach. Navigation is indicated in tumors \ 2 cm. The submandibular transcervical approach should be considered upfront for neoplasms B 7 cm, preferentially C 0.5 cm distant from skull base.

Trans-cervical approach to parapharyngeal space occupying lesion: case report

“…The transcervical approach is unique in that it permits extending the operating field based on the surgical findings. 12 Complications after surgical management are unavoidable. Expected complications are due to sacrifice of cranial nerves.…”

Endoscopy-Aided Combined Intraoral and Cervical Approach for a Huge Parapharyngeal Benign Tumor

“…Therefore, the mandibular swing approach is done for huge tumors; however, surgery itself is invasive to the patient, and malocclusion may occur. [12][13][14] The transoral approach is less invasive for the extirpation of tumors in the PS, and an assistance of endoscopy facilitates the surgery. 15 The use of an angle widener, formerly used in the dental clinic, facilitates the surgical procedure.…”

Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Literature

“…Its mobilisation over the facial nerve is enough to expose the tumor as can be seen in our transparotid and combined transparotidtranscervical approach cases. It is also emphasised here that a mandibulotomy can be prevented by using the transcervical approach or at times combining it with transparotid approach in most of the prestyloid space tumors [7,8]. Division of the stylomandibular ligament, posterior belly of digastric and stylohyoid provides greater access to the deep and superior PPS [9,10].…”