Parapharyngeal Space Tumor: Submandibular Approach Without Mandibulotomy

Abstract

Among all head and neck tumors, only 0.5% occur in the parapharyngeal space and 80% are benign tumors. Surgery is the cornerstone of treatment. The deep location of this space and surrounding structures has given rise to a large number of surgical approaches for resection of parapharyngeal neoplasms. Our experience using the submandibular transcervical approach on 14 patients who had surgery upfront for treatment of these lesions is described. This is a retrospective, descriptive case-series analysis of patients with parapharyngeal space tumors treated from January 2009 to July 2016, in whom carotid body tumors were excluded. Fourteen patients were included, 11 females (76.9%) and 3 males (23.1%), with a mean age of 46.9 years (SD 14.85). The most common symptom reported at patient’s presentation to our clinic was a foreign body sensation in the oropharynx and pain. Navigation-guided surgery was used in two cases. Mean tumor size was 4.7 cm (SD 1.785). Complete resection of lesions was performed in all cases, and the major complication was massive bleeding in one case (7.1%). According to the present analysis, the submandibular transcervical approach is an effective and safe technique that allows resection of large parapharyngeal tumors, even those close to the skull base. It has minimal complication rate, prevents morbidity associated mandibulotomy and allows extension to a transparotid, transmandibular and even to an infratemporal fossa approach. Navigation is indicated in tumors < 2 cm. The submandibular transcervical approach should be considered upfront for neoplasms ≤ 7 cm, preferentially ≥ 0.5 cm distant from skull base.