Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours

Marinescu Andreea,Ivodii Mirela,Hainăroșie Răzvan,Zainea Viorel,Othieno Theresa Mary,Tonu Angela,Ștefan Iemima,Ghiță Dragoș,Rădulescu Marian

doi:10.11648/j.ass.20200801.12

Abstract

Parapharyngeal space tumours are rare, mostly benign and present few symptoms, being difficult to diagnose it early. CT scan and MR are necessary for topographical diagnosis. Surgical resection is the best possible treatment option, but the approach remains a challenge, as there are several vital elements contained in the parapharyngeal space and, thus, adequate visualization is needed. Different surgical approaches have been described: transcervical-submandibular, transparotid, transmandibular, transoral and combined approaches. Transoral approach is the most controversial one due to cited limited exposure, which can lead to neurovascular injury or incomplete removal of the lesion. It is seldom performed and only for small, extra-parotid and non-vascular tumours of the parapharyngeal space. Wide access to endoscopic equipment in our institute allowed us to perform medium to large benign parapharyngeal tumour resection usig the transoral approach. The use of endoscopic assistance for transoral approach provided direct and magnified visualization of the parapharyngeal space, reducing tissue damage, ensuring adequate hemostasis (which lead to less amount of bleeding) and also confirming complete resection prior to closure. In addition, compared to transcervical approach, transoral approach shortened hospitalization time and improved cosmetic appearance. Benign parapharyngeal space tumours not involving critical structures from the parapharyngeal space can be completely resected by an endoscopic-assisted transoral approach with good functional and cosmetic outcome.

Highlights

Parapharyngeal space (PPS) is a challenging anatomic region hidden in the depth of the neck, containing vital structures and having limited access
Pain is unusual with benign lesions and may be due to compression or hemorrhage into the lesion; pain and neurologic dysfunction are more often indicative of Ștefan Iemima et al.: Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours malignancy with infiltration of the skull base
We propose the transoral approach to PPS tumours, along with direct visualization of the surgical field with the assistance of endoscopic surgery and image guidance

Summary

Introduction

Parapharyngeal space (PPS) is a challenging anatomic region hidden in the depth of the neck, containing vital structures and having limited access. Pain is unusual with benign lesions and may be due to compression or hemorrhage into the lesion; pain and neurologic dysfunction are more often indicative of Ștefan Iemima et al.: Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours malignancy with infiltration of the skull base. On CT or MRI, poststyloid tumours typically displace the PPS fat anterolaterally and the internal carotid artery in an anteromedial direction [11]. The transoral approach is the most controversial one as it offers poor exposition and does not give adequate control in the event of a haemorrhage It is seldom performed and only for small, extra-parotid and non-vascular tumours of the parapharyngeal space. Postoperative complications after surgery of the PPS include cranial nerve injury, tumor spillage, infection, Horner’s syndrome, first bite syndrome, trismus, hematoma, vascular injury, dysphagia, and Frey’s syndrome. Stylopharyngeus), the posterior belly of the digastric muscle and stylomandibular ligaments [21]

Methodology

Endoscopic Anatomy of PSS

Case Report

Discussions

Findings

Conclusions