Management Of Parapharyngeal Space Tumors Research Articles

Analysis of Diagnosis and Treatment Strategies for Parapharyngeal Space Tumors With Follicular Dendritic Sarcoma

Background: Parapharyngeal space tumor is a tumor that occurs in the parapharyngeal space. Parapharyngeal space tumors are uncommon, accounting for about 0.5% of head and neck tumors. Eighty percent of them are benign and 20% are malignant. The pathologic types of tumors are varied, mainly neurogenic tumors and salivary gland tumors. Follicular dendritic sarcomas are much rarer, with an inert biological behavior and a low-grade malignant sarcoma. Clinicians face difficulties in the management of this lesion. Therefore, a comprehensive analysis of the management of this disease is necessary. Case presentations: In May 2023, a 22-year-old male presented with pharyngeal discomfort, dysphagia, and sleep apnea. The patient underwent MRI which showed a rounded hypodense shadow with a size of 3.2×2.1×4.5 cm in the left lateral pharyngeal wall and a mass located in the posterior aspect of the left submandibular gland. After preliminary diagnosis of left parapharyngeal space tumor and left neck mass, the clinician performed transoral endoscopy-assisted resection of the left parapharyngeal space tumor and transcervical resection of the left cervical mass. The patient has been followed up without recurrence. Conclusions: This case provided a reference for the diagnosis and management of parapharyngeal space tumors. In particular, new insights into the diagnosis and management of a rare pathologic type were presented, which had the potential to improve the overall understanding of this disease.

Minimally invasive management of parapharyngeal space tumors: Introducing a decision-making algorithm and radiologic tool

ObjectiveTraditionally tumors of the parapharyngeal space (PPS) are resected through transcervical approaches. More recent approaches include endoscopic approaches or transoral robotic surgery (TORS) without directions on when to use which approach. Our objective was to find objective parameters to choose the most suitable approach. MethodsIt is a retrospective study containing 6 patients from May 2019 to May 2021 with tumors of the PPS treated in the Department of Otolaryngology and Head-Neck Surgery at the Hospital of Lucerne, Switzerland. ResultsThe data was analysed in average 53 months after surgery. Tumor resection was completed with TORS in 3 patients and endoscopically in 3 patients. Mean operation time was 114 min. No major complications occurred. No evidence of tumor was found in magnetic resonance imaging studies postoperatively in all patients. ConclusionWe conclude that a resection via TORS or endoscopic technique is safe and effective. Furthermore, we postulate that the further a tumor is located in the upper lateral area of the PPS, an approach via TORS is less possible.

Trends in the surgical management of parapharyngeal space tumors: A single-center retrospective analysis.

Surgery remains the mainstay treatment for parapharyngeal space (PPS) tumors. Given the rapid advance and increasing usage of endoscopic and robotic techniques, we aimed to investigate the surgical trends of PPS tumors in our institution and analyze their impact on patients' treatment outcomes. All patients who underwent surgical resection of PPS tumors from 2014 to 2021at the Eye, Ear, Nose, and Throat Hospital of Fudan University were retrospectively reviewed. Student's t-test, Chi-square test, and multinomial logistic regression analyses were used to compare the surgical outcomes between groups. Of the included 389 patients, the recipients of endoscopic surgery have largely increased in our center, with 17 of 134 cases (12.7%) in the group 2014-2017 and 187 of 255 cases (73.3%) in the group 2018-2021. The use of transoral and trans-nasal approaches increased in recent years (5.2% in 2014-2017 vs. 26.0% in 2018-2021), while that of trans-mandibular and lateral skull base approaches decreased (5.9% in 2014-2017 vs. 0.8% in 2018-2021). Decreased blood loss of operation and decreased risks of postoperative neurovascular complications were observed in the group 2018-2021. Similar findings were observed among patients receiving endoscopic surgery when compared with those receiving conventional surgery. In our institution, the overall trends in the surgical management of PPS tumors moved towards minimally invasive approaches with the assistance of endoscopy or surgical robots. The two surgical techniques were feasible and safe, and to a great extent, contributed to the improved surgical outcomes we observed in recent years.

Management of parapharyngeal space tumors with transparotid–transcervical approach: analysis of prognostic factors related with disease-control and functional outcomes

Different therapeutic strategies have been developed to improve surgical and functional outcome of parapharyngeal space (PPS) neoplasms. The transparotid-transcervical approach (TTa) is a valid surgical option to manage most PPS tumors. Its short- and long-term disease control and cranial nerve (c.n.) function outcomes have not been discussed extensively. All patients who underwent TTa over a 10-year period at a tertiary academic center were retrospectively reviewed. Data about preoperative imaging, clinical presentation, tumor's size, location and histology, and postoperative oncological and functional results were registered and analyzed. Sixty patients matched the inclusion criteria. Most of the lesions were benign (71.7%), involved the prestyloid PPS (63.3%) and measured more than 30mm (75%). Fifty-two (86.7%) lesions were resected en-bloc. Clear margins were achieved in 91.7% of the cases, with positive margins solely associated with malignancy (p = 0.008). Post-operative c.n. function was satisfactory, with X c.n. function significantly associated with the retrostyloid location (p = .00) and neurogenic tumors (p = 0.02). Local disease-control was achieved in 96% of the cases after a median follow-up of 46 (± 19.7-82.0 IQR) months. The TTa was safe and effective, achieving a satisfactory local control rate. Nevertheless, malignancies maintain a higher rate of positive margin due to their infiltrative nature and the complex anatomy of the PPS. In such cases, multiportal approaches might be more effective. However, post-operative c.n. function remained satisfactory, irrespective of lesions' size and histopathologic behavior. A higher X c.n. deficit rate was observed in retrostyloid and neurogenic lesions.

Transoral Parotidectomy.

Transoral parotidectomy allows for the management of parapharyngeal space tumors and accessory parotid gland tumors without the need for a transfacial/transparotid or mandible splitting procedure. It is a minimally invasive approach that permits a faster recovery and with a lesser risk of facial palsy.

Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review.

To perform a systematic review of studies evaluating Trans-oral Robotic Surgery (TORS) in the treatment of parapharyngeal space (PPS) tumors. A comprehensive electronic search was performed in PubMed/MEDLINE, Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted on November 9, 2019. Twenty-two studies were included for the systematic review which analyzed a total of 113 patients (median age 53.5, IQR 41.5-58.1). The most common PPS tumor treated with TORS was the pleomorphic adenoma (n=66; 58.4%). All tumors were successfully resected. The median tumor size was 4.8cm (n=73; IQR 3.8-5.4). Combined transcervical (TORS-TC) and transparotid (TORS-TP) approaches were used in 13 (11.5%) and 5 (4.4%) patients, respectively. Capsule disruption was noted in 11 cases (14.5%), while tumor fragmentation was observed in 7 patients (10.3%). The median time of hospitalization was 3days (n=79; IQR 2-4.1). Oral diet was possible from the day after surgery in the majority of patients (n=34, 68%). The most common complication was dysphagia (n=5, 4.5%). This systematic review confirms the safety and feasibility of TORS in the treatment of PPS lesions. Given the low quality of included studies, further evidence is needed in order to establish clinical guidelines.

Clinicopathological Study of Parapharyngeal Space Tumor

Objective: To see the mode of presentation, diagnosis and management of parapharyngeal space tumours.
 Study design: Cross sectional study.
 Setting: Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
 Methods: The condition being relatively rare, it was difficult to find good number of fresh cases. We have studied all cases of parapharyngeal space tumour attending in the Bangabandhu Sheikh Mujib Medical University from January 2010 to March 2011.
 Result: Parapharyngeal space tumours are rare head and neck neoplasms.The third decade of life showed greatest incidence. The main presenting complaint’s were painless neck swelling (73%). The highest number of pathology were attached to the deep lobe of parotid gland (pleomorphic adenoma-27%) and then neurofibroma (20%). Of all cases 77% were benign. Their accurate diagnosis and management is challenging.
 Bangladesh J Otorhinolaryngol; April 2017; 23(1): 41-46

Image-guided transnasal endoscopic fine needle aspiration or biopsy of parapharyngeal space tumours.

Parapharyngeal space biopsy is an important investigation in the management of parapharyngeal space tumours. These tumours are relatively rare and the surgeon is often faced with a wide range of differential diagnoses. There are several ways to access the parapharyngeal space, with varying degrees of associated morbidity. This paper describes a seldom used, but a simple and safe, image-guided endoscopic approach to parapharyngeal space biopsy that enables tissue to be obtained transnasally. The procedure is conducted under general anaesthesia using computed tomography image guidance via the LandmarX system, with transnasal access to the parapharyngeal space achieved using a sampling needle. This procedure is relatively simple, safe and reproducible. It is a less invasive approach to parapharyngeal space biopsy, and one which has been successfully used by the senior author for years without any significant morbidity. Transnasal image-guided endoscopic aspiration or biopsy of the parapharyngeal space is a novel technique that has not been previously described.

A comparative study of parapharyngeal space tumors over a 7 year period experience in tertiary care hospital

<p class="abstract"><strong>Background:</strong> Tumors of the parapharyngeal space (PPS) are rare, accounting for 0.5–1.5% of all head and neck tumors. The<strong> </strong>anatomy of the PPS is responsible for a wide variety of tumors arising from the PPS. Our series of 10 PPS tumors provides an overview of the clinical course and management of PPS tumors.</p><p class="abstract"><strong>Methods:</strong> This retrospective study included clinical data from patients treated for PPS tumors from 2011 to<strong> </strong>2018 at the Stanley medical college hospital, Chennai. </p><p class="abstract"><strong>Results:</strong> After careful analysis of the outcome of the study, we have found out that there was no local recurrence in any patient during the follow-up period. Though few approaches are advised in the literature, In our study transoral approach may be advocated as the first choice for excision of parapharyngeal space tumors, except for malignant tumors and neurogenic tumor. Trans cervical approach is used for malignant and neurogenic tumors, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck.</p><p class="abstract"><strong>Conclusions:</strong> In our study, middle aged male population was most commonly affected. Pleomorphic adenoma is the most common PPS tumor; prestyloid compartment is mostly affected by these tumors. As per the previous studies, trans cervical approach is first choice for excision of parapharyngeal space tumors. In our study, trans oral approach is also a suitable, safe approach for pre styloid non vascular lesions and trancervical approach can be reserved for postsyloid and malignant lesions.</p>

Operative techniques for the management of parapharyngeal space tumours: an experience in Asian Indian population

Operative techniques for the management of parapharyngeal space tumours: an experience in Asian Indian population

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.

Contemporary evaluation and management of parapharyngeal space neoplasms

This review summarises the contemporary, multidisciplinary approach to managing parapharyngeal space neoplasms. Parapharyngeal space neoplasms are uncommon head and neck tumours and are most often benign. Most tumours are of either salivary gland or neurogenic origin. Patients tend to be asymptomatic even when tumours reach large sizes. Patients may present with a mass in the pharynx or neck, although frequently the tumour is found incidentally on an imaging study. Due to the limitations of physical examination in this anatomical area, imaging studies are essential to the evaluation of parapharyngeal space neoplasms. Cytopathology may provide additional diagnostic information. Open biopsy is rarely necessary and can be hazardous. Treatment is primarily surgical, and various surgical approaches can be tailored for a given neoplasm. Recently, a trend toward observation of select patients with asymptomatic neurogenic tumours has been advocated. The evaluation and management of parapharyngeal space tumours is best done by a multidisciplinary team. Treatment should be individualised, and the risks and benefits of surgical intervention need to be carefully weighed. Complications are best avoided by careful surgical planning.

Surgical Management of Parapharyngeal Space Tumors: Our Experience

The purpose of this study is to evaluate parapharyngeal space (PPS) tumors with regards to clinico-pathological features and pre-operative assessment and also to analyze the benefits of transcervical approach in the management of PPS tumors. We performed retrospective analysis of patients who had undergone transcervical resection of PPS tumors from May 2006 to May 2009 at KLES Dr. Prabhakar Kore Hospital and M. R. C, Belgaum. Patients were diagnosed on the basis of clinical examination, FNAC and magnetic resonance imaging. All patients were observed with an annual follow-up of at least 3years by physical examination and ultrasonographic evaluation. The total number of patients were four; with three males and one female patient. Their age varied from 20 to 55years with a mean age of 36years. There were two cases of neurilemomas, one case of carotid body tumor and one case of pleomorphic adenoma. All four patients underwent surgical excision of tumor by transcervical approach. There were no major post-operative complications. All four patients are alive with no recurrence in the 3year follow-up period. Transcervical approach is versatile, flexible and provides good access to the narrow PPS. This approach also provides good vascular control and reduced risk of post-op complications. We recommend transcervical approach even for large sized pre-styloid and post-styloid compartment benign tumors which are free from deep lobe of parotid.

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.

The surgical management of parapharyngeal space tumors

We analyzed 7 cases of parapharyngeal space tumors and discussed our method of operation. In our department, we managed to resect the tumor without mandibular osteotomy. When this was possible, it meant the most minimally invasive surgery for the patient. This course has advantages in regards to post operation, duration of hospitalization and cosmetic results. In order to obtain operative fields, we dissected some structures from the cervical approach gradually. In the cases of neurogenic tumors, we resected the tumors after tumor reduction using CUSA. There was no recurrence after therapeutic resection, and there were fewer complications. From these results, we concluded that the decision regarding operative methods depends on the histology or the vascularity of the tumor rather than the size or the location.

Magnetic resonance imaging and the management of parapharyngeal space tumors.

The purpose of this study was to evaluate our experience with the diagnosis and management of tumors of the parapharyngeal space (PPS), with particular emphasis on the evolving role of magnetic resonance imaging (MRI). A case series review of 51 patients with parapharyngeal tumors who underwent surgical excision between 1980 and 1992 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique (computed tomography [CT] versus MRI), surgical approach, and outcome. Fifty-one patients underwent surgical excision of a parapharyngeal tumor of which the vast majority (78%) were benign neoplasms. Compared with benign neoplasms, the malignant tumors were much more likely to be associated with pain, trismus, and a cranial nerve deficit. MRI was able to locate the tumor in 20 of 21 patients (95%), while CT was able to localize the tumor in 32 of 38 patients (84%). MRI, because of its superior soft-tissue resolution and ability to provide imaging in multiple planes, is the imaging modality of choice to diagnose neoplasms of the parapharyngeal space. Because most of these tumors are benign, MRI allows the surgeon to select the surgical approach with the least morbidity.

Clinical presentation and management of parapharyngeal space tumours

Methods: Tumors originating in the parapharyngeal space are uncommon. During the period of January 1999 to December 2008. Among them 34 patients underwent surgery for parapharyngeal space tumors at the Department of Otolaryngology and Head Neck Surgery, Chittagong Medical College Hospital. Results: Ninety one percent of the parapharyngeal space neoplasms were benign; 9% were malignant. Majority of the benign tumors were salivary gland origin followed by neurogenic tumors. The use of FNAC, computed tomography scan and ultrasound imaging are very useful to assess the location, size, vascularity, tissue origin and relation of parapharyngeal space tumors to surrounding anatomical structures. Conclusion: This information was essential in planning surgical approaches and predicting the prognosis. Details of the management, morbidity, and outcome of these patients were presented. Key words: Tumor; Parapharyngeal space. DOI: 10.3329/bjo.v17i1.7626 Bangladesh J Otorhinolaryngol 2011; 17(1): 36-41