Approaches to Parapharyngeal Space Tumors

Abstract

Objective: Parapharyngeal tumors, owing to diversity of pathologies and the close proximity to vital structures, pose both a diagnostic enigma as well as a therapeutic challenge. The present study is an attempt to present our past 4 years experience in the surgical management of parapharyngeal tumors using various approaches. Method: A retrospective analysis of records of 22 patients who were operated for parapharyngeal tumors during the past 4 years was done. Only those cases where the primary neoplasm was of parapharyngeal space were included. The data so collected was analyzed for clinical presentation, radiological findings, surgical management and outcome. Results: The most common pathology found was salivary gland tumors (9) followed by neural origin tumors (5), carotid body tumor (2), and miscellaneous (6). Of the recommended approaches for parapharyngeal tumors, transcervical, trans-cervical transparotid, and transcervical with mandibular swing approaches were used in the present study, while trans-oral approach was not used. Transcervical transparotid approach was the most commonly used approach followed by transcervical approach. Transcervical with mandibular swing approach was used in cases with large tumors going to skull base. Size and extent of tumor along with type of pathology and vascularity were the main factors determining the approach selected. Conclusion: Transcervical transparotid and transcervical approaches are the most frequently used approach in the present study providing adequate exposure depending upon the extent of tumour in parapharyngeal space. Mandibular swing approach should be used for huge tumors where dissection under vision is not possible and vascular control is compromised otherwise.