Surgical Parapharyngeal Space Tumor Analysis with Case Series Study

Abstract

Background. The parapharyngeal space is a hypothetical region in the neck that stretches from the base of the skull to the bigger corner of the hyoid bone. The fascia that connects the styloid process to the tensor veli palatini separates the compartment into prestyloid and poststyloid compartments, with the prestyloid compartment being larger. In the general population, tumors of the parapharyngeal area are very uncommon, accounting for less than 1% of all head and neck neoplasms in the population. In this location, CT scanning and magnetic resonance imaging (MRI) exams are complimentary, and both tests should be performed to examine any lesions found. The most critical component of treatment is the total surgical removal of all the cancerous tissue. Identifying and treating primary parapharyngeal space (PPS) tumors are among the most challenging tasks in the treatment of head and neck cancer. They are also among the most aggressive ones. The primary goal of this study is to review our current knowledge at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, which serves as an academic tertiary referral center and a major teaching center. We will focus on clinical findings, tumor structure, tumor histological distribution, and surgical approaches. Materials and Methods. The processing starts with two modules. The first module starts with the input images obtained from various patients and collected as a database. The second module starts with the collection of case series of nine patients undergoing excision via multiple different approaches: transoral, transcervical, transparotid, transmandibular, or infratemporal approach. All cases were conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, between 2014 and 2018. All operative interventions were performed by an otolaryngology-head and neck surgeon. Results. Our study comprised nine patients, of which two underwent transparotid and seven transcervical and combined transcervical/transparotid approach. Complications faced included a hematoma in one of our cases. Conclusion. The transcervical approach appeared to be the superior surgical approach when facing a pleomorphic adenoma within the parapharyngeal space, arising from the deep lobe of the parotid gland or parapharyngeal space-occupying paraganglioma.

Midline mandibulotomy for large carotid body tumors: A valuable approach

“…The transmandibular approach or the mandibular swing/split approach has been preferred for tumors that extensively involve the parapharyngeal space, those with significant cephalad extension, those involving the internal jugular vein or carotid artery, large size tumors, and recurrent tumors. 9 Several methods are available to perform a mandibulotomy, including via the body (lateral mandibulotomy), the midline, and the paramedian. 10 The midline and paramedian line mandibulotomies with lateral dislocation of the ipsilateral jaw provide excellent visibility of the oral cavity and oropharynx.…”

Differentiation of neurogenic tumours and pleomorphic adenomas in the parapharyngeal space based on texture analysis of T2WI

“…It is composed of a complex structure. PPS tumours are uncommon and account for less than 1% of all head and neck neoplasms [ 1 ]. PPS is anatomically surrounded by several important structures, including the anterior styloid space and posterior styloid space formed by the styloid process.…”