Benign Parapharyngeal Space Tumors Research Articles

Neurological Complications in Benign Parapharyngeal Space Tumors - Systematic Review and Meta-Analysis.

Introduction Parapharyngeal space tumors with complex anatomy and diverse histology have remained a challenging phenomenon for treating physicians. Objectives We have conducted a comprehensive web search on the PubMed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM), and Clinicaltrials.gov databases to determine the factors that are associated with postoperative complications in parapharyngeal space tumors. Data Synthesis Two researchers reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. The systematic review has identified 631 benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies, with a mean age of 42.9 ± 7.76 years old and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement, and proximity to great vessels or to the skull base were the deciding factors in selecting the surgical approach. The factors considered to select the surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae ( p = 0.106). Tumors with neurogenic histology have significantly increased chances of developing neurological complication (OR 6.07; p = 0.001). Conclusion Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.

Primer Benign Parafarengeal Boşluk Tümörlerinde Görüntüleme ve İnce İğne Aspirasyon Biyopsisinin Önemi

Primer Benign Parafarengeal Boşluk Tümörlerinde Görüntüleme ve İnce İğne Aspirasyon Biyopsisinin Önemi

Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours

Parapharyngeal space tumours are rare, mostly benign and present few symptoms, being difficult to diagnose it early. CT scan and MR are necessary for topographical diagnosis. Surgical resection is the best possible treatment option, but the approach remains a challenge, as there are several vital elements contained in the parapharyngeal space and, thus, adequate visualization is needed. Different surgical approaches have been described: transcervical-submandibular, transparotid, transmandibular, transoral and combined approaches. Transoral approach is the most controversial one due to cited limited exposure, which can lead to neurovascular injury or incomplete removal of the lesion. It is seldom performed and only for small, extra-parotid and non-vascular tumours of the parapharyngeal space. Wide access to endoscopic equipment in our institute allowed us to perform medium to large benign parapharyngeal tumour resection usig the transoral approach. The use of endoscopic assistance for transoral approach provided direct and magnified visualization of the parapharyngeal space, reducing tissue damage, ensuring adequate hemostasis (which lead to less amount of bleeding) and also confirming complete resection prior to closure. In addition, compared to transcervical approach, transoral approach shortened hospitalization time and improved cosmetic appearance. Benign parapharyngeal space tumours not involving critical structures from the parapharyngeal space can be completely resected by an endoscopic-assisted transoral approach with good functional and cosmetic outcome.

Surgical treatment of benign tumors of parapharyngeal space

Background: Neoplasms of the oropharynx and parapharyngeal space are quite rare, characterized by nonspecific development of the disease, and the involvement of important anatomical structures in the pathological process. Problems of diagnosis and choice of tactics of surgical treatment are relevant today. Aim: To evaluate the effectiveness of transoral approach when removing benign tumors of the parapharyngeal space. Materials and methods: In State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Sciences of Ukraine” in recent years, 92 patients underwent surgical treatment with benign tumors of the parapharyngeal space. Men – 39 (42.4%), women – 53 (57.6%). All patients underwent total removal of the tumor in the parapharyngeal space by transoral approach. Results: In patients evaluated the postoperative period, the type of postoperative wound healing, the presence of complications and the quality of life. The following postoperative complications were observed: in 13 (14.1%) patients lockjaw was observed, which regressed on average for 2-3 days, bleeding from the postoperative site in the early postoperative period – 4 (4.3%) and acute cerebrovascular accident in the early postoperative period in 1 patient (1.1%). Conclusions: Given the good blood supply to the parapharyngeal space, bleeding is one of the most common complications. Vascular complications are more common when neurogenic or vascular tumors are removed. Angiography is useful in evaluating post-styloid lesions in order to demonstrate their connection with large vessels and differentiate neurogenic and vascular lesions. The advantages of transoral removal of the tumors of the parapharyngeal space are the absence of cosmetic defects, the rapid healing of postoperative wounds and the rapid restoration of the patient’s working capacity.

A comparative study of the endoscopy-assisted transoral approach versus external approaches for the resection of large benign parapharyngeal space tumors

The advantages and limitations of the endoscopy-assisted transoral approach (EATA) and external approaches (EAs) in resection of parapharyngeal space tumors (PSTs) remain unclear. In our study, we compared the use of the EATA and the EAs for the resection of large, benign PSTs. Forty-four patients with PSTs were divided into the EATA and EA groups. The perioperative and postoperative outcomes of the patients were evaluated. All of the tumors were completely removed. However, the procedure was converted to an open procedure for four patients in the EATA group and for six patients in the EA group who required endoscopic assistance. The intraoperative blood loss, amount and duration of drainage, postoperative pain, total hospital stay, and cosmetic outcomes were superior in the EATA group (P<.05). Use of the EATA for resection of large, benign PSTs decreased the surgical invasiveness of the procedure and resulted in better aesthetic outcomes. However, use of the combined surgical approach allowed for improved access for the resection of PSTs.

Recent advances in surgical management of parapharyngeal space tumors.

To summarize nuances in the surgical management of parapharyngeal space (PPS) tumors aimed to reduce postoperative sequelae without affecting oncologic outcomes. The contemporary trend in surgery of PPS tumors is to develop minimally invasive approaches that allow tumor resection without the need for mandibulotomy or lateral skull base approaches. This can be obtained by refining well established surgical routes like the transcervical, improving those with limited applications like the transoral, and developing novel corridors like the transnasal (or the transoral/transvestibular). Therefore, careful surgical planning is mandatory in order to tailor treatment according to the patient and characteristics of the tumor, in view of a wide and heterogeneous choice of techniques (to be employed alone or in combination). Technical refinements of transcervical and transoral approaches may lead to reduction in the rate of mandibulotomy performed for benign PPS tumors. This is also true when considering the possibility of combined approaches that provide excellent exposure and management of the upper PPS up to the skull base.

Resection of macrosis benign parapharyngeal neoplasms via oral approach

To explore investigate the feasibility of transoral removal of macrosis benign neoplasms in parapharyngeal space. Sixteen patients with well-defined macrosis benign parapharyngeal space tumors treated by surgery from January 2005 to December 2012 were enrolled in this study. All patients were assessed by CT scan, MRI and CT angiography before surgery. Surgery for the tumors with complete peplos, locating at medial side of carotid and accessible from the oropharynx was completed with the assistance of endoscope, bipolar electrocoagulation or radiofrequency ablation system. All neoplasms were removed by transoral approach. Tracheotomy was performed in 4 cases. All patients were treated successfully with good postoperative recovery and no significant complications. Postoperative pathological examination showed there were 9 cases of pleomorphic adenoma, 5 cases of neurilemmoma and 2 cases of neurofibroma. By the follows-up of 1-8 years (median 31 months), among 16 cases only one case of neurofibroma recurred. The transoral removal of macrosis benign neoplasms in parapharyngeal space is safe, manimally invasive and feasible in selected cases, with a high local control rate and a low surgical complication rate.

Lateral skull base approaches in the management of benign parapharyngeal space tumors.

To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach. Retrospective study of patients with benign parapharyngeal space tumors. The clinical features, radiology and preoperative management of skull base neurovasculature, the surgical approaches and overall results were recorded. 46 patients presented with 48 tumors. 12 were prestyloid and 36 poststyloid. 19 (39.6%) tumors were paragangliomas, 15 (31.25%) were schwannomas and 11 (23%) were pleomorphic adenomas. Preoperative embolization was performed in 19, stenting of the internal carotid artery in 4 and permanent balloon occlusion in 2 patients. 19 tumors were approached by the transcervical, 13 by transcervical-transparotid, 5 by transcervical-transmastoid, 6, 1 and 2 tumors by the infratemporal fossa approach types A, B and D, respectively. Total radical tumor removal was achieved in 46 (96%) of the cases. Lateral skull base approaches have an advantage over other approaches in the management of benign tumors of the parapharyngeal space due to the fact that they provide excellent exposure with less morbidity. The use of microscope combined with bipolar cautery reduces morbidity. Stenting of internal carotid artery gives a chance for complete tumor removal with arterial preservation.

Transcervical approach for removal of benign parapharyngeal space tumors

Tumors of the parapharyngeal space are rare. Owing to the deep location and minimal symptoms in early stages, they typically present at an advanced stage. Traditional transmandibular techniques of excision are associated with a high degree of morbidity, and low acceptance by patients for what is in most cases a benign condition. However, most of these tumors can be removed very elegantly via a transcervical approach, with minimal morbidity. This article presents our technique for transcervical removal of parapharyngeal tumors. Using this technique, the risk of complications is low, and oncologic outcomes are excellent.

Parapharyngeal space benign tumours: Our experience

Only about 0.5% of all head and neck neoplasms occur in the parapharyngeal space (PPS) and approximately 80% of these tumours are benign lesions. Various surgical approaches some of which are associated with mandibulotomy to increase exposure have been described. This article describes our 16-years' experience in treating 60 PPS benign tumours with special focus on our surgical techniques intended to ensure adequate mass exposure and structure safety. On the basis of our experience we assert that mandibulotomy is currently not advocated in the surgical management of benign PPS tumours i.e. not even in very select cases. The transparotid approach is the treatment of choice for parotid gland lesions involving PPS and in cases of multinodular or uninodular pleomorphic adenoma relapse involving the PPS. The transcervical approach is suitable for the safe removal of even large PPS masses in most cases.

Transcervical Approach to Benign Parapharyngeal Space Tumors

We describe our experience with the postoperative sequelae, complications, and recurrences associated with resection of a series of parapharyngeal space (PPS) tumors via a transcervical approach without submandibular gland excision, parotidectomy, or mandibulotomy. We performed a retrospective review of 51 cases, 40 of which were pleomorphic adenomas and 11 of which were lipomas or schwannomas. Of 30 fine-needle aspirations performed, 24 indicated pleomorphic adenoma before operation. Twenty-eight of the 30 fine-needle aspirations yielded diagnoses that were consistent with the final pathologic diagnoses. The average hospital stay was 1.05 days. After operation, there were 9 cases of trismus, 4 cases of "first bite" pain, and 7 cases of transient marginal nerve weakness. There were no recurrences over an average follow-up of 115 months. The majority of PPS tumors are benign. It is important to use an approach that allows complete tumor excision but does not impart undue postoperative morbidity. We demonstrate that the transcervical approach without submandibular gland excision, parotidectomy, or mandibulotomy is ideal for benign PPS tumors.

Extracapsular dissection for minimal resection of benign parapharyngeal tumor

Extracapsular dissection (ECD) is thought to be effective in treating benign tumors and minimally invasive. Nonetheless, its application and feasibility in treating benign parapharyngeal space (PPS) tumor, the neoplasm located in the complex anatomical space, have never been investigated. The aim of this study is to evaluate the utility and efficacy of transcervical ECD in treating benign PPS tumors. From 1996 to 2009, 54 patients with PPS tumors were treated by the designated surgeon. Excluding nine patients who were initially regarded as the potential candidates for ECD treatment but failed to meet the inclusion criteria, 22 patients who received the procedure were retrospectively analyzed. In 22 enrolled patients, 10 had pleomorphic adenoma while 6 had neurilemmoma. There were 13 PPS tumors located in the prestyloid space and 9 in the poststyloid space. The median volume of PPS tumors was 22.6 cm(3), and the median distance from tumor to skull base was 2.3 cm. The median length of incision was 4.5 cm with the ECD intervention. No major intra- or post-operative complications were noted and post-operative courses were unremarkable in long-term follow-up. This study demonstrates that ECD is an effective and safe treatment for selected benign PPS tumors. It has a favorable clinical outcome and an acceptable aesthetic result, and can be performed in a minimally invasive fashion. Therefore, it is suggested that ECD be included in the treatment modalities of benign PPS tumors.

Parapharyngeal space tumors without mandibulotomy: our experience

Parapharyngeal space (PPS) tumors are rare and benign in 80% of cases. Since surgeons first resected this anatomical region, the surgical approach to PPS bulks has been a hot topic due to their shape and the important structures involved. We present a series of patients treated with a transcervical or transcervical-transparotid approach to benign PPS tumors without mandibulotomy. Between May 2003 and March 2009, 18 patients (11 male and 7 female) with benign PPS tumors underwent a surgical resection, avoiding mandibulotomy. Average age of the patients was 49 years (range 3-76), average tumor size was 5.5 × 4 × 3 cm and histological examination of the resected tumors showed: seven pleomorphic adenomas of the deep parotid lobe, four schwannomas, two mycobacteriosis, two paragangliomas of the vagus nerve, one lipoma, one neurofibroma and one cavernous hemangioma. Seven patients underwent a transcervical approach, while 11 patients underwent a transcervical-transparotid approach. Excision of benign PPS tumors is possible without mandibulotomy even in the case of a large tumor mass, but exposure with the mandible in situ is certainly poor. Avoiding mandibulotomy reduces patient morbidity and hospital stay. In our experience, mandibulotomy can be avoided in most cases of benign PPS tumors leaving this procedure for malignant tumors or in patients with very poor exposure.

Single, subcondylar mandibular osteotomy: a new access route for extensive, benign parapharyngeal neoplasms

We report a new approach to benign parapharyngeal space tumours: a single, subcondylar mandibular osteotomy. Case report and review of the world literature concerning parapharyngeal space access and the various types of mandibular osteotomy. The use of a single, subcondylar mandibular osteotomy achieves good exposure and satisfactory aesthetic and functional results, using a simple, easily performed technique that is fast and has minimal morbidity. In addition, this technique preserves the submandibular gland and avoids lip-splitting and post-operative intermaxillary fixation. To our knowledge, this is the first report of this approach to the parapharyngeal space. We propose this approach as the first choice for resection of benign neoplasms of the parapharyngeal space.

Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images

Many approaches to the parapharyngeal space have been reported. However, few reports describe parapharyngeal space tumours and the best surgical approach to these tumours. We retrospectively examined the surgical approaches we used to resect 22 parapharyngeal space tumours. In order to determine the best surgical approach for each tumour, we first subdivided the parapharyngeal space into six compartments, based on anatomical landmarks seen on computed tomography and/or magnetic resonance imaging scans. We then determined the location of each tumour relative to these six parapharyngeal space compartments. In our series of cases, we found that large tumours spanning the superior portion of the parapharyngeal space could be completely removed through a skull base approach. To remove a large tumour in the middle and inferior portion of the parapharyngeal space, a transparotid approach was the most suitable. Finally, a tumour in the inferior portion of the parapharyngeal space was best accessed through a transcervical approach.

Surgical management of parapharyngeal space tumors: A 10-year review

The purpose of this article is to describe the diagnostic evaluation and surgical approaches to parapharyngeal space tumors in a tertiary referral center. The study is a retrospective review of 47 patients diagnosed with tumors of the parapharyngeal space (12 with malignant diseases and 35 with benign lesions) and surgically treated during a 10-year period. The transcervical (40%) and the transcervical-transparotid approaches (46%) were the most commonly performed surgical procedures followed by the orbitozygomatic-middle fossa approach (12%) and the transmandibular approach (2%). The surgical procedures were uneventful and there were no postoperative mortalities. Complications were rare; the most common was transient facial nerve paralysis (5 patients). After an average follow-up of 35 months, only 1 of 35 patients with benign diseases had a recurrence 5 years following transcervical resection of a pleomorphic adenoma. Of 12 patients with malignant tumors, 5 (42%) are alive with no evidence of disease. The sensitivity of preoperative fine needle aspiration biopsy (n = 23 patients) was 87% for detection of malignant disease and specificity was 100%. Most benign parapharyngeal space tumors can be removed surgically with a low rate of complications and recurrence. Malignant neoplasms, however, carry an ominous prognosis and a low rate of disease-free survival. Fine needle aspiration may be helpful in preoperative diagnostic evaluation of patients with parapharyngeal space tumors.

Stylomandibular tenotomy in the transcervical removal of large benign parapharyngeal tumours

We used a simple modification of the transcervical approach in a selected group of nine patients with large benign parapharyngeal space tumours, all of whom met the following inclusion criteria: The tumour was benign on fine needle aspiration, the encapsulated tumour was not attached to skull base or great vessels in the parapharyngeal space on imaging. Adequate exposure was achieved by just dividing the stylomandibular ligament and retracting the mandible anteriorly. It was possible to remove the tumours successfully and safely in all nine patients without the need for mandibulotomy or superficial parotidectomy. In seven cases, the tumour crossed the midline. There were no major perioperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumour.