Palato-pharyngeal approach to the parapharyngeal space

Abstract

Parapharyngeal space tumours present a great challenge to the surgeon with respect to pre-operative evaluation as well as surgical approach. The aim of surgical endeavour is to excise the tumour in toto with least morbidity to the patient. There are various approaches to the parapharyngeal space viz: (1) transcervical (2)transoral (3)transparotid (4)transparotid-transmandibular etc. The transcervical approach is suitable for tumours presenting in the neck but not extending into the upper parapharyngeal space. The transoral route has been traditionally condemned, though this route has been used to excise small relatively avascular benign tumours of parapharyngeal space, which present intraorally and are not palpable in the neck. Transparotid approach is the commonly used approach to excise tumours presenting in the upper parapharyngeal space, displacing the tonsil and palate. This approach is combined with mandibulotomy in cases of very large tumours. The palato-pharyngeal approach described in this paper allows excellent access to the whole length of the parapharyngeal space from base of skull to the hyoid bone. Recently, interest has been generated in this approach, referred to as transpalatal or palatal split approach. There is minimal bleeding and morbidity using this surgical approach.