Parapharyngeal Tumors Research Articles

Surgical approach to Parapharyngeal Tumours - Our Experience

IntroductionThe complex anatomy of the parapharyngeal space, the surrounding vital structures and late presentation of the tumours affecting this space pose difficult surgical challenge to every otolaryngologist. The study gives an overview of the experience in managing parapharyngeal tumours in a tertiary care setting.
 Materials And MethodsFifteen patients with parapharyngeal tumours were treated surgically in a medical college hospital in Kolkata in the three year study period. Surgical approaches were chosen, considering the size, site, extent and histology of the tumours.
 ResultsMost of the patients (33.33%) were from 20-30 years age group. 60% were females. The most common presenting feature was neck swelling. 80% of the cases were benign.The most common histologic variant was Schwannoma. The tumours were accessed through Trans-cervical, Trans-cervical Trans-parotid or Trans-cervical with Midline Mandibulotomy approaches. The most common post-operative complication was wound dehiscence.
 DiscussionThe most common presentation of a parapharyngeal mass was neck swelling mainly behind the angle of mandible (86.67%). Younger patients in their third decade of life were found to be affected more. Gadolinium enhanced MRI was found to be the most important investigation in parapharyngeal tumours. Complications were minimal.
 ConclusionA conservative trans-cervical approach was found to be feasible and effective in majority of the cases over radical ones, which may be required in malignancies and skull-base involvement.

Middle infratemporal fossa less invasive approach for radical resection of parapharyngeal tumors: surgical microanatomy and clinical application.

Surgery of the infratemporal fossa (ITF) and parapharyngeal area presents a formidable challenge to the surgeon due to its anatomical complexity and limited access. Conventional surgical approaches to these regions were often too invasive and necessitate sacrifice of normal function and anatomy. To describe a less invasive transcranial extradural approach to ITF parapharyngeal lesions and to determine its advantages, 17 patients with ITF parapharyngeal neoplasms who underwent tumor resection via this approach were enrolled in the study. All lesions located in the ITF precarotid parapharyngeal space were resected through a small operative corridor between the trigeminal nerve third branch (V3) and the temporomandibular joint (TMJ). Surgical outcomes and postoperative complications were evaluated. Pathological diagnosis included schwannoma in eight cases, paraganglioma in two cases, gangliocytoma in two cases, carcinosarcoma in one case, giant cell tumor in one case, pleomorphic adenoma in one case, chondroblastoma in one case, and juvenile angiofibroma in one case. Gross total resection was achieved in 12 cases, near-total and subtotal resection were in 3 and 2 cases, respectively. The most common postoperative complication was dysphagia. Surgical exposure can be customized from minimal (drilling of retrotrigeminal area) to maximal (full skeletonization of V3, removal of all structures lying lateral to the petrous segment of internal carotid artery) according to tumor size and location. Since the space between the V3 and TMJ is the main corridor of this approach, the key maneuver is the anterior translocation of V3 to obtain an acceptable surgical field.

Modified Blair Incision versus Modified Facelift Incision Combined with Sternocleidomastoid Muscular Flap in Parotidectomy

Background and ObjectivesZZTo evaluate the feasibility of a modified facelift incision with sternocleidomatoid muscular (SCM) flap as a first-line surgical approach for a parotidectomy by comparison with the modified Blair incision. Subjects and MethodZZFrom March 2011 to February 2014, 66 patients who underwent parotidectomy were enrolled in the study and their medical records were reviewed retrospectively. Patients with suspicious malignant tumor, metastatic lymph node, and parapharyngeal tumor in the preoperative examination were excluded from the study. Patients and tumor profiles, surgi cal outcomes, complications, and cosmetic outcomes were studied to compare the modified facelift incision between the SCM flap group (n=32) and the modified Blair incision group (n=34). ResultsZZThere were no significant differences between the two groups with respect to tumor location, tumor size, extent of surgery, operative times, postoperative drainage, and any type of complications. The modified facelift incision with SCM flap group had higher scar satisfaction scores than the modified Blair incision group (8.5 vs. 5.7, p＜0.001). ConclusionZZModified facelift incision with SCM flap can be used as a first-line surgical ap proach for parotidectomy in benign parotid tumor with better cosmetic outcome without increased complications.

Primary parapharyngeal tumours: a review of 21 cases.

The diagnostic and therapeutic procedures performed in a series of patients with primary parapharyngeal space (PPS) tumours treated at the ENT Departments of San Giovanni Bosco Hospital, Turin, and of the Pugliese-Ciaccio Hospital, Catanzaro, Italy, in the period 2001-2010 are evaluated. The retrospective review included 20 patients, 11 male and 9 female, average age of 41 years operated on for 21 primary PPS tumours. The most common tumours found were neurogenic neoplasms, while those of salivary origin were the next most common. There were 14 paragangliomas (7 originating from carotid glomus, 5 from vagal and 2 from tympanicum), 1 sympathetic chain schwannoma and 6 pleomorphic adenomas. All the tumours were benign in nature and gave rise to few signs or symptoms. Patients underwent preoperative computed tomography (CT) scan or magnetic resonance imaging (MRI) or both. Most contrast-enhanced masses were submitted to some type of angiography. Most of the surgeries were planned through imaging alone, as preoperative fine needle aspiration (FNA) biopsy was performed only in six cases. Four different approaches were adopted for tumour removal: transcervical, transcervical/transparotid, cervical-transparotid-transmandibular and infratemporal fossa approach. There was no operative mortality, though neurologic morbidity was significant. Follow-up, extended to a maximum of 11 years, did not reveal any recurrences. In conclusion, neurogenic tumours may be the most common of PPS masses. Surgery is the mainstay treatment and external approaches offer the potential for satisfactory tumour resection. Of such external approaches, transcervical and cervical/transparotid are the most often used in benign forms. The number of perioperative complications encountered in this series confirms the difficulty of performing surgery in this complex area, even in benign cases. The chances of avoiding vascular damage and saving the trunks or most of the nerve fibres involved depend not only on the skill and experience of the surgeon but also on the anatomy of the lesion, the type of connection between the tumour and the nerve from which it originates and the distribution of neural fibres in or around the tumour mass.

Transoral robotic resection of parapharyngeal space tumors

Parapharyngeal space (PPS) tumors are routinely resected by a transcervical or transmandibular approaches. However, recent developments in techniques of transoral robotic surgery (TORS) now allow the utility of the da Vinci robotic system for removal of PPS tumors with minimal morbidity. In this paper, we describe in detail the setup and surgical technique of TORS for removal of large parapharyngeal tumors. TORS provides high-magnification, 3-dimensional visual access to lateral-based structures and enables direct visualization at and around the tumor. The 5-mm robotic-guided arms enable an assistant to introduce additional instruments into the operating field to aid retraction, suction, and cauterization. Robotic surgery is rapidly becoming integrated into transoral head and neck surgery. The utility of TORS improves the surgical removal of selected tumors in the PPS with minimal morbidity and excellent functional and cosmetic outcomes.

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.

A Rare Tumor of the Parapharyngeal Space

Parapharyngeal space tumors are uncommon, most are salivary gland tumors (50%), and they are often pleomorphic adenomas. Neurogenic tumors are the second most common primary tumors of all neoplasms in the parapharyngeal space (30%). Angiomyxolipoma is a very rare form of lipoma. Up until now, only 12 cases located on different sides of the body were reported. Presented here is a case report of a patient with an angiomyxolipoma of the parapharyngeal space. A 17-year-old boy had a slowly growing, painless mass on the left side of the neck. During the oropharyngeal examination, medial displacement of the left tonsilla palatina was observed. Magnetic resonance imaging findings were of a 6 × 5.5 × 3-cm "dumbbell"-shaped parapharyngeal mass. A fine needle aspiration of the mass showed no specific histopathology. The patient underwent a transparotid-transcervical approach for the excision of the tumoral mass under general anesthesia. Although an angiomyxolipoma is a rare form of lipoma, it is a pathology that should be kept in mind for the differential diagnosis of parapharyngeal tumors.

Endoscopic Transnasal Approach to the Infratemporal and Upper Parapharyngeal Tumors: Indications and Outcomes

Objectives: Describe the endoscopic transnasal approach to the infratemporal fossa (ITF) and upper parapharyngeal region (UPR), and analyze the indications and outcomes of this surgical technique in the management of the tumors localized in this critical area. Methods: Retrospective review of patients with benign and malignant tumors arising in or extending to the ITF and UPR, treated from 2002 to 2012 at a single institute. The tumors were surgically resected using an endoscopic transnasal transmaxillary transpterygoid approach, combined with a posterior septotomy to improve the controlateral maneuverability of surgical instruments. Results: Thirty-one consecutive patients with benign tumors (20 juvenile nasopharyngeal angiofibromas, 2 extracranial trigeminal schwannomas, 2 meningiomas, and 1 cavernous hemangioma) and malignancies (2 adenoid-cystic carcinoma, 1 mucoepidermoid carcinoma, 1 squamous-cell carcinoma, 1 adenocarcinoma, and 1 recurrence of chondrosarcoma after chemo-radiation therapy) were treated with curative intent. A gross-total resection was achieved in 28/30 patients. Major complications were observed in 1 case (intra-operative internal carotid artery blowout), and minor complications (postoperative palate and/or cheek numbness) were observed in 4 cases. Postoperatively, the 5 primitive malignancies received intensity-modulated radiotherapy. Mean follow-up was 30 months for malignancies and 54 months for benign tumors. All patients are now alive without recurrences, with stable intracranial persistence of disease in 2 cases (1 meningioma and 1 adenoid-cystic carcinoma). Conclusions: The purely endoscopic transnasal technique may provide a minimally-invasive and safe approach to resect selected tumors involving the ITF and UPR. Larger case series and longer follow-up are needed to validate the reproducibility and efficacy of this technique.

Resection of parapharyngeal neoplasms via styloid diaphragm approach

To evaluate the surgical technique and efficacy of the resection of parapharyngeal space neoplasm via styloid diaphragm approach. Thirty-three cases underwent the resection of parapharyngeal space tumors via styloid diaphragm approach from Jan 2005 to Jan 2011 were reviewed. Of the cases, 28 were with benign tumors treated by surgery alone, and 5 were malignant tumors treated by surgery plus postoperative radical radiotherapy. The parapharyngeal neoplasms in all cases were completely resected via styloid diaphragm approach. The postoperative follow-up ranged from 13 months to 7 years (median = 4.6 years). No tumor recurrence was found in 30 cases, but 3 cases experienced tumor recurrence, including 1 chondrosarcoma (3 years after surgery and chemoradiotherapy), 1 chordoma and 1 adenoid cystic carcinoma (5 years after surgery and radiotherapy). Severe postoperative complications were not observed, but 2 cases showed mild mouth askew and fully recovered after 3 months, and 1 case was complicated with hoarseness and cough symptoms that disappeared after heteropathy. Resection of parapharyngeal neoplasms via styloid diaphragm approach is an ideal surgical technique, with well-exposed surgical field, less tissue injury, and less postoperative complication.

Secondary Trigeminal Neuralgia Caused by Pharyngeal Squamous Cell Carcinoma - A Case Report -

Trigeminal neuralgia (TN) is characterized by recurrent paroxysms of unilateral facial pain that typically is severe, lancinating, and activated with cutaneous stimulation. There are two types of TN, classical TN and atypical TN. The pain nature of classical TN are the same as those described above, whereas atypical TN is characterized by constant, burning pain. We describe the case of a 49-year-old male presenting with right-sided facial pain. The patient was diagnosed with temporomandibular joint disorder at a dental clinic and was on medical treatment, but his symptoms worsened gradually. He was referred to our pain clinic for further evaluation. Radiologic evaluation, including MRI, showed a parapharyngeal tumor. For the relief of TN, a right mandibular nerve (V3) root block was performed at our pain clinic, and then he was scheduled for radiation and chemotherapy.

Mandibular Subsigmoid Access Osteotomy in the Management of Parapharyngeal Space Tumors

Primary parapharyngeal space tumors are rare presentation in the head, face, neck region. Most of these tumors are benign in nature and significantly cast a challenge in terms of diagnosis and their surgical management. Anatomical location of these tumors, either prestyloid or poststyloid, size of the tumor, and proximity to the vital structures determine the appropriate surgical approach. The surgical approach to the parapharyngeal tumors should provide adequate visibility and access for complete removal, preserving the adjacent vital structures and also preventing recurrence. We report our experience in diagnostic workup and management of a series of 18 primary parapharyngeal space tumors with long-term follow-up.

Parapharyngeal Space Surgery via a Transoral Approach Using a Robotic Surgical System: Transoral Robotic Surgery

In transoral robotic surgery (TORS), if an endoscopic arm equipped with two integrated cameras is placed close to a lesion, a three-dimensionally magnified view of the operative field can be obtained. More important is that the operation can be performed precisely and bimanually using two instrument arms that can move freely within a limited working space. We performed TORS to treat several diseases that occur in the parapharyngeal space (PPS) and subsequently analyzed the treatment outcomes to confirm the validity of this procedure. Between February 2009 and February 2012, 11 patients who required surgical treatment for the removal of a parapharyngeal lesion were enrolled in this prospective study. Nine patients received TORS for parapharyngeal tumor resection, and 2 patients with stylohyoid syndrome underwent TORS for resection of an elongated styloid process. The average age of the patients included in this study was 42 years. Five patients were male, and 6 patients were female. TORS was successfully performed in all 11 patients. The average robotic system docking and operation times were 9.9 minutes (range, 5-24 minutes) and 54.2 minutes (range, 26-150 minutes), respectively. Patients were able to swallow normally the day after the operation. The average blood loss during the robotic operation was minimal (11.8 mL). The average hospital stay was 2.6 days. There were no significant complications in the perioperative or postoperative period. All patients were extremely satisfied with their cosmetic outcomes. PPS surgery via a transoral approach using a robotic surgical system is technically feasible and secures a better cosmetic outcome than the transcervical, transparotid, or transmandibular approach. This new surgical method is safe and effective for benign diseases of the PPS.

An Unusual Parapharyngeal Tumor: Cervical Sympathetic Chain Schwannoma

Journal of Case Reports in Medicine,2013,2,1,1-4.Published:April 2013Type:Case ReportAuthors:G. M. Divya, K. Ramachandran, and Libin T. Balan Author(s) affiliations:G. M. Divya, K. Ramachandran, and Libin T. Balan Department of ENT, Government Medical College, Kozhikode, Kozhikode-673008, Kerala, INDIA. Abstract:Abstract Schwannomas are benign, solitary, and well-differentiated tumors originating from Schwann cells. They may originate from any of the peripheral, cranial, or autonomic nerves of the body with the exception of the olfactory and the optic nerves. Schwannomas arising from the cervical sympathetic chain are very rare. Only < 65 cases have been reported in the literature to date. Here we report a case of cervical sympathetic chain schwannoma in a 41-year-old lady presenting as a parapharyngeal mass which was excised by a transcervical approach without any postoperative Horner’s syndrome. Keywords:Parapharyngeal tumor; Cervical sympathetic chain; SchwannomaView:PDF (1.12 MB) PDF Images Figure 1: At presentation, a 7×4 cm firm swelling is seen at the left carotid triangle.

Approaches to Parapharyngeal Space Tumors

Objective: Parapharyngeal tumors, owing to diversity of pathologies and the close proximity to vital structures, pose both a diagnostic enigma as well as a therapeutic challenge. The present study is an attempt to present our past 4 years experience in the surgical management of parapharyngeal tumors using various approaches. Method: A retrospective analysis of records of 22 patients who were operated for parapharyngeal tumors during the past 4 years was done. Only those cases where the primary neoplasm was of parapharyngeal space were included. The data so collected was analyzed for clinical presentation, radiological findings, surgical management and outcome. Results: The most common pathology found was salivary gland tumors (9) followed by neural origin tumors (5), carotid body tumor (2), and miscellaneous (6). Of the recommended approaches for parapharyngeal tumors, transcervical, trans-cervical transparotid, and transcervical with mandibular swing approaches were used in the present study, while trans-oral approach was not used. Transcervical transparotid approach was the most commonly used approach followed by transcervical approach. Transcervical with mandibular swing approach was used in cases with large tumors going to skull base. Size and extent of tumor along with type of pathology and vascularity were the main factors determining the approach selected. Conclusion: Transcervical transparotid and transcervical approaches are the most frequently used approach in the present study providing adequate exposure depending upon the extent of tumour in parapharyngeal space. Mandibular swing approach should be used for huge tumors where dissection under vision is not possible and vascular control is compromised otherwise.

Rare Malignant Parapharyngeal Tumors: Is There a Dilemma?

Objective: To study the clinical, radiological, and histopathological characteristics along with the treatment outcome of 23 patients presenting with malignant parapharyngeal space tumors. Method: Retrospective chart review between 2001 to 2010, at Department of Otolaryngology–Head and Neck Surgery, Chandigarh, India. Retrospective analysis of malignant parapharyngeal tumors from 2001 to 2010. Subjects: Twenty-three patients. Interventions: Clinical, radiological, and histopathological characteristics. Outcome measures: Disease-free survival at 1 year. Results: Out of 23 cases, 17 were rare malignancies of the parapharyngeal space. Of these, 6 tumors arose de novo (sarcoma, squamous cell carcinoma, synovial sarcoma, fibrosarcoma, rhabdomyosarcoma, and leiomyosarcoma) and 3 were direct extension of deep lobe parotid tumor (undifferentiated carcinoma with neck metastasis). Other rare tumors were extra osseous chordoma of the parapharyngeal space (n = 1), malignant fibrous histiocytoma (n = 1), malignant ameloblastoma (n = 1), malignant melanoma extending to the infratemporal fossa (n = 1), malignant schwannoma (n = 1), malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation (triton tumor; n = 1), neurofibroma with atypia (n = 1), and extraosseus Ewing’s sarcoma (n = 1). Fourteen out of 23 (60.8%) patients are alive with no evidence of disease on variable follow up with mean follow up of 15 months. Conclusion: Tumors of the parapharyngeal space are uncommon, comprising less than 1% of all head and neck neoplasms. Accurate diagnosis and management is challenging and requires a team approach. When the diagnosis is ambiguous, a complete surgical excision and histopathological examination should be the preferred approach for these rare tumors.

Clinicopathologic study of parapharyngeal tumors

Background:Parapharyngeal space (PPS) tumors are rare. Three main groups are identified, namely those of salivary origin, neurogenic tumors and paragangliomas. Early pathological classification of PPS tumors is important for pin point diagnosis and timely management.Aims:The PPS is a complex anatomical potential space and poses high risk of per and postoperative complication. This study was done to perform optimum preoperative evaluation by clinicoradiologic correlation and guided fine needle aspiration cytology (FNAC) which is essential to minimize intraoperative risk.Materials and Methods:Guided FNAC was carried out to diagnose parapharyngeal tumors in 48 patients from January 2008 to January 2010. The inflammatory lesions were excluded in the present study. Correlation with histopathology was done in all the cases.Results:The mean age for all the patients was 38.2 years. There were 23 male and 25 female subjects. Seventy nine percent of the lesions were benign with pleomorphic salivary adenoma being the commonest, while only 20.8% of the lesions were malignant. All the patients presented with neck swelling. No complication was encountered in the present study.Conclusion:FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report.

Imaging Features of Extra Cranial Parapharyngeal Space Meningioma: Case Report

Parapharyngeal tumors are less common in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial parapharyngeal space meningioma presenting as a cervical mass with encasement of cranial nerves giving tram track appearance and features on various imaging modalities [Radiographs, Ultrasound, Computed tomography (CT) scan and Magnetic resonance imaging (MRI)].

Poster 19: Utilization and Avoidance Patterns of Lip Splitting Mandibulotomy for Oral and Oropharyngeal Tumor Access in a Maxillofacial-Oriented Unit

Statement of the ProblemThe lower lip splitting incision with associated mandibulotomy is widely used in head and neck cancer surgery to provide access to intraoral, pharyngeal and parapharyngeal tumors as well as to the cervical spine. While providing wide access, these incisions have been associated with less appealing esthetic results than combined transoral and cervical approaches that do not violate the lip and orbicularis oris.Materials and MethodsA retrospective review of five years of patients with oral and oropharyngeal malignant and benign tumors treated at the Head and Neck Surgical Associates of Portland, Oregon, which is a maxillofacial surgery unit where avoidance of the lip-spitting mandibulotomy is commonplace, will be described. The situations where lip-splitting mandibulotomy is needed will be discussed, as will those situations where it can be avoided. The literature with respect to functional outcomes and cosmesis with lip splitting mandibulotomy will also be reviewed.Methods of Data AnalysisRetrospective case series.Results of InvestigationCertain factors such as trismus, extensive tumor extension to the tonsillary fossa and prior radiation therapy may require the lip-splitting mandibulotomy approach.ConclusionHead and Neck units with a background in oral and maxillofacial surgery may have an advantage in the application of transoral surgical approaches to the oral/oropharyngeal tumor patient. Improved cosmesis can be achieved by avoidance of the lip splitting mandibulotomy where feasible. Statement of the ProblemThe lower lip splitting incision with associated mandibulotomy is widely used in head and neck cancer surgery to provide access to intraoral, pharyngeal and parapharyngeal tumors as well as to the cervical spine. While providing wide access, these incisions have been associated with less appealing esthetic results than combined transoral and cervical approaches that do not violate the lip and orbicularis oris. The lower lip splitting incision with associated mandibulotomy is widely used in head and neck cancer surgery to provide access to intraoral, pharyngeal and parapharyngeal tumors as well as to the cervical spine. While providing wide access, these incisions have been associated with less appealing esthetic results than combined transoral and cervical approaches that do not violate the lip and orbicularis oris. Materials and MethodsA retrospective review of five years of patients with oral and oropharyngeal malignant and benign tumors treated at the Head and Neck Surgical Associates of Portland, Oregon, which is a maxillofacial surgery unit where avoidance of the lip-spitting mandibulotomy is commonplace, will be described. The situations where lip-splitting mandibulotomy is needed will be discussed, as will those situations where it can be avoided. The literature with respect to functional outcomes and cosmesis with lip splitting mandibulotomy will also be reviewed. A retrospective review of five years of patients with oral and oropharyngeal malignant and benign tumors treated at the Head and Neck Surgical Associates of Portland, Oregon, which is a maxillofacial surgery unit where avoidance of the lip-spitting mandibulotomy is commonplace, will be described. The situations where lip-splitting mandibulotomy is needed will be discussed, as will those situations where it can be avoided. The literature with respect to functional outcomes and cosmesis with lip splitting mandibulotomy will also be reviewed. Methods of Data AnalysisRetrospective case series. Retrospective case series. Results of InvestigationCertain factors such as trismus, extensive tumor extension to the tonsillary fossa and prior radiation therapy may require the lip-splitting mandibulotomy approach. Certain factors such as trismus, extensive tumor extension to the tonsillary fossa and prior radiation therapy may require the lip-splitting mandibulotomy approach. ConclusionHead and Neck units with a background in oral and maxillofacial surgery may have an advantage in the application of transoral surgical approaches to the oral/oropharyngeal tumor patient. Improved cosmesis can be achieved by avoidance of the lip splitting mandibulotomy where feasible. Head and Neck units with a background in oral and maxillofacial surgery may have an advantage in the application of transoral surgical approaches to the oral/oropharyngeal tumor patient. Improved cosmesis can be achieved by avoidance of the lip splitting mandibulotomy where feasible.

Clinicopathologic Review of Mucoepidermoid Carcinoma

Objective: 1) Describe the epidemiology of mucoepidermoid carcinoma (MEC) in the head and neck treated at a tertiary care hospital. 2) Determine clinical and pathologic predictors of recurrence and survival in patients with mucoepidermoid carcinoma in the head and neck treated at a tertiary care hospital. Method: Medical records of 94 patients (mean age, 50.4 years; M:F, 48:46) who underwent surgical treatment for MEC of the head and neck between 1995 and 2010 were reviewed. Main outcome measures were DFS, DSS, and OS. Clinicopathologic parameters evaluated were age, sex, TNM stage, subsite, adjuvant therapy, tumor grade, and margin status. Results: Of the 94 patients, 42 parotid, 26 palate, 12 oral, 9 submandibular/sublingual, 4 orbital, and 1 parapharyngeal tumors were identified. All patients underwent surgical resection, 32 patients had postoperative radiation and 3 postoperative chemoradiation. The 5-year OS and DSS were 79% and 90% with a median follow-up of 72 months and 45 months, respectively. The 5-year DFS was 74% with 12 patients developing recurrence. On univariate analysis, age &gt;50 ( P = .01), male sex ( P = .008), positive nodal status ( P = .01) and high-grade histology ( P = .003) were predictive of poor prognosis. On multivariate analysis, high-grade histology ( P = .02) and male sex ( P = .04) were predictive of poor prognosis. Conclusion: The epidemiology of MEC is consistent with previous studies. High grade histology continues to be the strongest independent predictor of survival in MEC followed by male sex. Further studies into the molecular biology of MEC that may account for such clinicopathologic features are warranted.

Update on the management of parapharyngeal tumours

Parapharyngeal space (PPSp) tumours are uncommon and hence the 'generalist expertise' for diagnosis and treatment is limited. Recent improvements in radiology and cytopathology mean the likely diagnosis is more certain and hence the recommended surgical treatment can be more definitive. A wide spectrum of primary pathologies are reported to involve the PPSp; the majority (80%) are benign neoplasms. Radiological imaging, computed tomography (CT) and MRI, with diagnostic fine needle aspiration cytology (FNAC), have continued to increase preoperative diagnostic accuracy. Thus, it is easier to identify the patients whose external surgery may rarely require a mandibulotomy. Only highly selected cases can be safely excised via a transoral approach. All tumours of the PPSp require accurate diagnosis, using modern diagnostic imaging and FNAC. Surgery, in most cases, remains the treatment of choice. Many neurogenic tumours and paragangliomas can be observed in elderly patients. The optimum surgical approach for complete excision needs to be selected on an individual basis. Each patient must be adequately informed of the associated morbidity and possible complications, likelihood of cure and the risk of tumour recurrence - short and long term. Most tumours can be excised safely, and with low risk of recurrence and short hospitalization, with a cervical-parotid approach.