Transoral Robotic Surgery for Parapharyngeal Space Tumors Reduces Risk of Postoperative First Bite Syndrome

Abstract

Background: Transoral robotic surgery (TORS) has extended the applications of transoral surgery for a variety of conditions. Tumors of the parapharyngeal space (PPS) may be excised with a minimally invasive approach transorally and TORS provides many technical advantages. Our early experience with TORS parapharyngeal space resection suggests that one major advantage of TORS over open surgery for prestyloid tumors is the relatively infrequent occurrence of first bite syndrome (FBS). Objective: This study aims (1) to evaluate the prevalence of FBS in TORS PPS resection and (2) to compare the prevalence of FBS in our largest subset of patients (prestyloid parapharyngeal space pleomorphic adenoma) to a control group of patients who had open surgery with parapharyngeal pleomorphic adenoma (PA) resection. Methods: An IRB-approved retrospective review of parapharyngeal space resection was conducted. Patients who underwent TORS and those who underwent parapharyngeal space resection for PA were included. Results: A total of 43 patients underwent TORS resection. Only one patient experienced signs or symptoms of first bite syndrome. This patient had a schwannoma of the sympathetic chain. Overall, 26 patients had TORS resection of PPS minor salivary gland tumors, and 21 of these patients were for pleomorphic adenoma. None of these patients experienced FBS. Among a similar cohort who underwent open resection, 7 of 21 did experience symptoms of FBS. This difference is highly significant (p < 0.05). Conclusion: Although the study is not randomized, our series of prestyloid parapharyngeal space pleomorphic adenoma cases has accumulated to a significant cohort. The complete absence of FBS in our TORS group and the high prevalence of FBS for open resection of PPS pleomorphic adenoma in both the literature (range, 22–60%) and our control group (33%) strongly suggest that the transoral approach reduces the risk of FBS in this group. It also supports the theory of sympathetic denervation of the parotid gland, which appears less likely to occur from the transoral approach. Transoral robotic surgery for removal of parapharyngeal space tumors has numerous advantages and is considerably less invasive than open surgery. Our most frequent indication for TORS PPS resection is minor salivary gland pleomorphic adenoma. Absence of FBS appears to be one of the major benefits of TORS parapharyngeal space resection for this group or patients.