Parapharyngeal carcinosarcoma treated with an endoscopic-assisted transcervical approach: a case report

Abstract

: Primary tumors of the parapharyngeal space (PPS) are very rare, accounting for approximately 0.5–1.5% of all head and neck tumors. Most of them are benign lesions (80%) and pleomorphic adenoma is the most common, followed by neurogenic tumors. Multiple surgical approaches have been described, each one offering various functional outcomes, and the transcervical approach still represents the workhorse for head and neck surgeons confronting the PPS. Large tumors, or those located in the upper part of PPS, often require greater mobilization of neural and vascular structures, or combined routes with a mandibulotomy or an infratemporal fossa approach, therefore associated with considerable morbidity. In the present study we report the case of an 81-year-old woman with persistence of a PPS malignant tumor, after radiation treatment. A surgical resection via an endoscopic-assisted transcervical approach was performed. Complete tumour removal was obtained. No intra-, peri- or post-operative complications were reported. Histopathological findings were consistent with salivary carcinosarcoma. Routinely, PPS tumors are removed through the transcervical approach. Recently, several surgical minimal invasive approaches to PPS have been described, employing endoscopic and robotic assistance via transnasal and transoral windows. The endoscopic-assisted transcervical approach PPS allowed us to remove the tumor in conditions of good visualization, preventing neurovascular injuries and tumor spillage.