Endoscopy Assisted Transoral Approach (EATA) of a parapharyngeal tumour – Acosmetically acceptable approach

Abstract

When considering tumours of the parapharyngeal space,surgeons are presented with a difficult decision regarding the surgical approach balancing cosmetically acceptable outcome with clear resection margins. With careful patient selection and preoperative evaluation, it is possible to obtain both of the desired outcomes through an endoscopic assisted transoral approach (EATA). This approach does not require any new and expensive equipment and utilises existing ENT infrastructure decreasing operating cost and patient morbidity and is reproducible with an acceptable learning curve. Case overview: An 83-year-old gentleman with multiple comorbidities presents with a left-sided parapharyngeal space tumour with progressive enlargement over the past eight months. This tumour was excised using a two-man endoscopic assisted transoral approach (EATA) and the subsequent cavity was also repaired trans-orally. The post-operative stay was uneventful and the patient was discharged in 2 days. Histology revealed the mass to be a non-Hodgkin’s lymphoma for which the patient is currently undergoing treatment. Conclusion: Current literature advocates the use of endoscopic assisted transoral approach (EATA) for excision of carefully selected patients presenting with parapharyngeal masses. This approach should be considered whenever possible given the alternative approaches which have significant cosmetic penalties.