Tumors of the parapharyngeal space: the VU University Medical Center experience over a 20-year period

Abstract

BackgroundTumors of the parapharyngeal space (PPS) are rare, accounting for 0.5–1.5% of all head and neck tumors. The anatomy of the PPS is responsible for a wide variety of tumors arising from the PPS. This series of 99 PPS tumors provides an overview of the clinical course and management of PPS tumors.Materials and methodsThis retrospective study included clinical data from patients treated for PPS tumors from 1991 to 2012 (warranting at least a 4-year follow-up) at the VU University Medical Center, Amsterdam, The Netherlands.ResultsFifty percent were salivary gland tumors, 41% were neurogenic and 9% had a different origin. 18.2% of the PPS tumors were malignant. The most reported symptom at presentation was swelling of the neck and throat. In 14%, the PPS tumor was an accidental finding following imaging for other diagnostic reasons. Cytology showed an accuracy rate of 73.1% (19/26). The positive predictive value of a malignant cytology result was 86% (95% CI 42.1–99.6%). Surgery was performed in 55 patients (56%). The most frequently performed approach (56%) was the cervical–transparotid approach, followed by the cervical (25%), transmandibular (16%) and transoral (2%) approach. Nine patients died of the disease, of which seven patients had a malignant salivary gland tumor, one patient had a pleomorphic adenoma at first diagnosis which degenerated into carcinoma ex pleomorphic adenoma and one patient died of metastatic renal cell carcinoma.ConclusionThis large single-centre report on PPS tumors shows that careful diagnostic work up and proper surgical planning are important in this specific and rare group of head and neck tumors. Surgery was the main treatment (56%) for parapharyngeal tumors. Management of parapharyngeal neurogenic neoplasms generally consists of active surveillance due to peri-operative risk for permanent cranial nerve damage. The histopathological diagnoses were consistent with previous reports.

Endoscopic transoral approach for resection of retrostyloid parapharyngeal space tumors: Retrospective analysis of 16 patients

“…4,11 However, most of the previous studies have been limited to lesions within the prestyloid PPS. [8][9][10][11][12][13][14][15][16][17] The majority of tumors originating in the prestyloid PPS are pleomorphic adenomas arising from the deep lobe of the parotid gland. 18 Tumors in the retrostyloid PPS, however, mainly originated from the lower cranial nerves (IX-XII) or sympathetic trunk; therefore, they displace the ICA in an anteromedial direction.…”

“…4,9 However, most of the reports are limited to the prestyloid PPS tumors (ie, pleomorphic adenoma). 10,11 Tumors originating from the retrostyloid PPS were considered to be a relative contraindication for transoral resection, 12 and have been rarely reported to be resected through a transoral approach. 13 The anteromedial position of the internal carotid artery (ICA) and difficulty to expose the superior and lateral borders of the tumor may restrict the use of the approach for retrostyloid PPS tumors.…”

Transoral endoscopic approach versus transcervical with or without mandibular swing approach to parapharyngeal space- a retrospective cohort study in a tertiary care center in Tamil Nadu

“…3 These tumors can be pleomorphic adenoma from minor salivary gland or parotid gland (40%) or can be neurogenic tumors like schwannomas (14%) or paragangliomas (20%), malignant salivary tumors (13%), miscellaneous malignant tumors (7%) and miscellaneous benign tumors (6%). 4,5 These tumors should be surgically excised for symptomatic relief from mass effect and to avoid malignant transformation in case of benign tumors like pleomorphic adenomas. Complex anatomy of parapharyngeal space makes any approach challenging.…”

Transoral endoscopic surgical approach to venous malformation of the parapharyngeal space

“…Tumors of the PPS are rare, accounting for 0.5%-1.5% of all head and neck tumors. 1,2 Furthermore, venous malformations (VMs) of the PPS are uncommon, accounting for ⩽2% of all PPS tumors. 1,3 We present a case of a female patient with a VM of the PPS, which was resected using a fully transoral endoscopic surgical approach.…”