Primary Parapharyngeal Space Tumors Research Articles

Radiological research methods in the diagnosis and treatment of patients with the parapharyngeal space tumors

The parapharyngeal space is a complex structure, being narrow and difficult for surgical approach. Surgical treatment is the main treatment for parapharyngeal space (PPS) tumors, it is performed on the basis of information obtained from imaging methods (computed tomography (CT) and magnetic resonance imaging (MRI)). Objective – to investigate the effectiveness of advanced visualization of radiological research methods in the diagnosis of the parapharyngeal space tumors in order to select the necessary tactics of surgical treatment. This retrospective study included 43 patients who underwent surgery for primary parapharyngeal space tumors from 2010 to 2021. 32 patients were treated in previous 10 years, 11 – patients who underwent examination and surgical treatment over the past 2 years with advanced methods of MRI and CT to select a safe surgical approach. Patients of the 2nd group underwent advanced MRI and CT studies in order to choose the correct method of surgical approach and prevent postoperative complications and recurrence. The histological conclusion in 90.1% of the operated patients confirmed the preliminary data of MRI perfusion regarding the probable histological structure of the neoplasm. Due to a comprehensive preoperative study, in 81.8% of patients in this group transoral approach was used. Our experience confirms the necessity for a thorough preoperative diagnostic procedure that should take advantage of imaging modalities (CT, MRI), especially new techniques (MRI-perfusion and diffusion weighted imaging).

Surgical Parapharyngeal Space Tumor Analysis with Case Series Study.

Background The parapharyngeal space is a hypothetical region in the neck that stretches from the base of the skull to the bigger corner of the hyoid bone. The fascia that connects the styloid process to the tensor veli palatini separates the compartment into prestyloid and poststyloid compartments, with the prestyloid compartment being larger. In the general population, tumors of the parapharyngeal area are very uncommon, accounting for less than 1% of all head and neck neoplasms in the population. In this location, CT scanning and magnetic resonance imaging (MRI) exams are complimentary, and both tests should be performed to examine any lesions found. The most critical component of treatment is the total surgical removal of all the cancerous tissue. Identifying and treating primary parapharyngeal space (PPS) tumors are among the most challenging tasks in the treatment of head and neck cancer. They are also among the most aggressive ones. The primary goal of this study is to review our current knowledge at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, which serves as an academic tertiary referral center and a major teaching center. We will focus on clinical findings, tumor structure, tumor histological distribution, and surgical approaches. Materials and Methods The processing starts with two modules. The first module starts with the input images obtained from various patients and collected as a database. The second module starts with the collection of case series of nine patients undergoing excision via multiple different approaches: transoral, transcervical, transparotid, transmandibular, or infratemporal approach. All cases were conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, between 2014 and 2018. All operative interventions were performed by an otolaryngology-head and neck surgeon. Results Our study comprised nine patients, of which two underwent transparotid and seven transcervical and combined transcervical/transparotid approach. Complications faced included a hematoma in one of our cases. Conclusion The transcervical approach appeared to be the superior surgical approach when facing a pleomorphic adenoma within the parapharyngeal space, arising from the deep lobe of the parotid gland or parapharyngeal space-occupying paraganglioma.

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

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

Surgical Treatment of Primary Parapharyngeal Space Tumors: A Single-Institution Review of 28 Cases

This study evaluated the surgical treatment of tumors arising from the parapharyngeal space (PPS) in a single-center setting. This retrospective study was conducted with 28 patients who underwent surgery for primary PPS tumors from 2011 to 2018. Patient clinical features, histologic tumor type, surgical approach, complications, and follow-up data were evaluated. All patients underwent surgery in this series. The transmandibular approach was most frequently performed (35.7%), followed by the transcervical (28.6%), transparotid (17.9%), and transoral (17.9%) approaches. A surgical navigation system was applied to the surgery of 4 cases with superior PPS tumors. The mean surgical duration of these cases (205.0minutes) was shorter than that of cases without surgical navigation, and the mean maximum size (MMS) of tumors (5.8cm) was larger (P<.01). Eleven different tumor types were diagnosed after surgery (78.6% benign and 21.4% malignant). For postoperative complications, there were 10 cases of lower lip numbness, 4 of facial nerve dysfunction, 2 of trismus, and 1 each for the remaining types. During 4- to 81-month follow-up, 27 patients had no recurrence, metastasis, or death and 1 patient was lost to follow-up. The histopathologic diagnoses were consistent with those of previous reports. Surgical resection is the main treatment for PPS tumors, with relatively low rates of recurrence and death. For superior PPS tumors, the surgical navigation system can substantially shorten the operative duration and is more suitable for larger tumors.

Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions: Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Contemporary management of primary parapharyngeal space tumors.

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.

Surgical management of primary parapharyngeal space tumors in 103 patients at a single institution

Purpose: To evaluate clinical features, diagnosis, surgical management, and treatment of parapharyngeal space tumors in a single-center setting due to limited knowledge of diagnosis and treatment of parapharyngeal space.Methods: Clinical records of 103 patients were included for the analysis of such clinical characteristics.Results: A total of 29 different types of tumors were diagnosed after operation: 20 benign and 9 malignant. With a follow-up of 31–84 months for 90 benign cases, 84 cases had no recurrence and 6 cases were lost to follow-up. In contrast, with an 8- to 51-month follow-up for 13 malignant cases, 11 patients died and 2 were lost to follow-up. Furthermore, for postoperative complications, 3 cases had Horner syndrome, 2 had hoarseness, 2 had facial nerve dysfunction, and each for other types.Conclusions: Surgery remains the first choice for the treatment of parapharyngeal space tumors, with the transcervical approach used for most tumors. Moreover, CT or MRI may assist in making decisions about operation schemes.

Surgical treatment of parapharyngeal space tumors: A report of 29 cases.

The present study aimed to establish a strategy for parapharyngeal space (PPS) tumor surgery based on preoperative symptoms, clinical signs, imaging and histological examination. A retrospective cohort study was conducted with 29 adult patients who underwent surgery for primary PPS tumors from 2008-2015. The following data was obtained: Preoperative symptoms of the patient, histological type of the tumor, surgical approach and complications. Of the 29 patients who underwent surgery to remove a PPS tumor, 16 presented with neurogenic tumors and 13 with salivary gland tumors. The most common symptom was the presence of a neck mass. Preoperative computed tomography and magnetic resonance imaging were performed to evaluate the size and location of the tumors. The majority of the salivary gland tumors were located in the prestyloid space, whereas all neurogenic tumor cases were poststyloid. A total of 21 of the 29 patients (72.4%) underwent a preoperative fine needle aspiration (FNAC) examination. FNAC contributed to preoperative diagnosis in 9 of these cases (42.9%). In parotid tumors of the prestyloid space, facial nerve palsy was a common postoperative complication. In the case of neurogenic tumors, a common complication was the postoperative palsy of the nerve of tumor origin. The strategy for PPS surgery, from the preoperative diagnosis to the operative method, remains controversial. The data on pre- and postoperative symptoms, imaging and histological diagnosis, and the selection of surgical method depending on a neurogenic or salivary tumor origin in the present study indicated that improving the method of examination, carefully selecting the method of approach and accurately managing surgery leads to complete tumor removal, and that the use of nerve-preserving techniques may reduce the likelihood of complications.

Surgical management of primary parapharyngeal space tumors: a 10-year review

Conclusions: Most neoplasms of the parapharyngeal space are benign. The transcervical surgical approach is the preferred procedure in most cases. Intra-operative endoscopic exploration offers a new surgical management technique to reduce operative complications and post-operative recurrence rates.Objectives: To present the authors’ experience in the treatment of primary parapharyngeal space tumors with emphasis on surgical approaches and employment of endoscopy to detect residual tumors through conventional approaches.Method: One hundred and sixty-seven patients treated surgically over a 10-year period were retrospectively reviewed. A comparison of the surgical approaches in a relevant case series was also conducted.Results: All of the patients underwent pre-operative imaging before surgery, and intra-operative endoscopic detection was selectively used for large, deep tumors. Complete resection of the tumor was used in 158 patients (95%), with a transcervical surgical approach applied in 144 cases (84%). Of 167 tumors, 150 (90%) were benign and 17 (10%) were malignant, with neurilemmoma/schwannoma as the most frequent pathology (42%). Surgical complications were reported in 26 patients (15%), most commonly unilateral paralysis of the vocal cords (6%). Two patients (1%) presented with recurrence, on average 2.5 years (range = 1–4 years) after initial excision, and the mean follow-up time was 3.8 years (range = 10 months–10 years).

A Study of Primary Parapharyngeal Space Tumors in a Tertiary Care Center

ABSTRACTObjectivesThis study was conducted to evaluate the demographic profile, clinicopathological features, and surgical approaches used to treat primary parapharyngeal space tumors.Materials and methodsThis was a retrospective study of the primary parapharyngeal space tumors treated surgically from April 2012 to March 2015 in a tertiary care teaching center. The study population included 16 cases. The inflammatory lesions and secondary metastasis in parapharyngeal space were excluded. The clinicopathological features, surgical management, and outcome of all the cases were analyzed.ObservationsThe gender distribution was 56.2% males and 43.7% females. The median age was 38 years with range from 16 to 62 years. The most common presenting symptom was neck swelling in 87.5% cases, and oropharyngeal bulge was the most common examination finding in 100% cases. Magnetic resonance image was done in 87.5% cases and contrast computed tomography (CT) scan in 31.25% cases, while 25% cases underwent both. The tumor was in the pre-styloid compartment in 62.5% cases and post-styloid in 31.25% cases. In 75% cases, cytology was done directly, while in 25% cases, CT–guided cytology was performed. Cytological diagnosis was histologically correlated in 81.2% cases while changed in 18.7% cases. On histology, 87.5% cases were benign and 12.5% were malignant. The most common histological variant was pleomorphic adenoma in 56.25% cases. The most common surgical approach used was transcervical in 75% cases. Mean tumor size was 7 cm. Complications occurred in 12.5% cases.ConclusionImaging modalities in combination with fine needle aspiration cytology are a very good diagnostic tool before planning for intervention. The transcervical approach is an excellent technique to deal with small to moderate-size tumors and even for large well-defined tumors.How to cite this articleBist SS, Kumar L, Agarwal V, Shirazi N, Luthra M. A Study of Primary Parapharyngeal Space Tumors in a Tertiary Care Center. Int J Otorhinolaryngol Clin 2016;8(1):13-17.

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.

当科における副咽頭間隙腫瘍手術症例の検討

This study is a retrospective review of the clinical records of patients operated on for parapharyngeal space (PPS) tumors. Between April 2005 to September 2011, 8 patients (2 men, 6 women, mean age 61.3 years) with primary PPS tumors underwent surgical resections by the same operating team. Different surgical approaches were used according to the type of lesion, exact location, and size: transcervical in 3 patients, transcervical-transparotid in 4 patients, and transparotid in 1 patient. Mandibulotomy was performed in 3 patients (mandibular swing in 1, subcutaneous mandibular splitting in 2). The PPS tumors were all successfully removed with no significant perioperative complications. One patient presented with Frey syndrome 1 year later. Histological examination of the resected tumors showed 6 salivary gland tumors and 2 schwannomas. Of the 6 salivary gland tumors, 2 were malignant. Our experience in the treatment of PPS tumors confirms the importance of preoperative assessment before every surgical resection in order to plan surgical treatment with a safe approach and which reduces aesthetic/functional damage. Intraoperative monitoring of multiple cranial nerves using NIM nerve monitoring systems is useful in the identification and preservation of neurological function in schwannoma.

Diagnostic accuracy and safety of fine‐needle aspiration biopsy of the parapharyngeal space

Fine-needle aspiration (FNA) biopsy of the parapharyngeal space (PPS) is a diagnostic challenge and sampling is often done without image guidance, often trans-orally. Primary PPS tumors are rare, and there is a broad differential diagnosis. The accuracy of PPS FNA, in particular without CT-guidance and using liquid-based cytology (LBC), has not been well studied. Pathology records from our institution (a 1,100 bed Canadian academic tertiary care centre) were searched to identify all patients who underwent PPS FNA from September 1991 to August 2009. The FNA diagnosis was compared to the gold standard of subsequent histopathology or long-term clinical follow-up. Of 36 FNAs, 3 employed image guidance. Eleven (31%) FNAs were nondiagnostic. In the 25 diagnostic FNAs, there was sensitivity 89%, specificity 94%, PPV 89%, NPV 94%, and accuracy 92% for the diagnosis of positive or negative for malignancy. A correct specific diagnosis was made in 9/25 (36%) cases. The nondiagnostic rate was significantly higher (P < 0.025) in FNAs prepared as conventional smears (9/17 = 53%) versus LBC (2/19 = 11%). A specific diagnosis was made significantly more often (P < 0.05) with LBC (8/19 = 43%) versus conventional smear (1/17 = 5.9%). One minor complication from FNA occurred. In conclusion, PPS FNA is safe and accurate for the diagnosis of malignancy. The rate of reporting a specific diagnosis is low. Nondiagnostic FNAs are common. There are more specific diagnoses and fewer nondiagnostic tests with LBC than with conventional smears. Improved specimen quality with LBC is likely a factor.

Tumeurs parapharyngées : diagnostic et traitement

Objectives Parapharyngeal space tumors are rare and usually benign. Their treatment is surgical and many approaches have been described. We report our experience in managing these neoplasms. Two points are developed more fully: the correlation between imaging and surgical observation and the reliability of the cervical approach. Material and methods A retrospective review of primary parapharyngeal space tumors treated at the Rennes University Hospital between 1992 and 2004 is presented. Nine patients were included, all treated surgically with a cervical approach without parotidectomy. Results Eight MR imaging and seven CT scans were done. Two retrostyloid tumors and six prestyloid tumors, all independent of the deep lobe of the parotid gland, were found. They were benign in all cases (five salivary tumors and four schwannomas). Two patients treated for a pleomorphic adenoma presented recurrence and were reoperated successfully. The average follow-up was 66 months. None of the patients died. Definitive postoperative complications occurred only for neurogenic tumors. Conclusion The cervical approach is safe and allows the surgical excision of retrostyloid and prestyloid tumors, independent of the deep lobe of the parotid gland. Large tumor (8 cm in our study) excision can be done with few complications. An attentive study of preoperative imaging is necessary to choose the best surgical approach.

Primary parapharyngeal space tumors in a Mexican cancer center

To describe clinical and demographic characteristics of the parapharyngeal space tumors and assess surgical approaches used to treat them at our institution. A retrospective and descriptive study of the parapharyngeal space tumors, excluding paragangliomas, treated from June 1991 to October 2002 in a cancer center. The study population included 21 patients, 8 men and 13 women, average age of 41 years (range, 20 to 70 years). Fine needle biopsy was done in 5 (24%) patients. Computed tomography (CT) was performed in all patients, and only a few required magnetic resonance image (MRI). Surgical approaches included transcervical alone or in combination with parotidectomy, transoral, or transmandibular (mandibular swing) approach. Laminectomy and segmentary approaches were also performed in 1 patient each. Sixteen (76%) patients had benign lesions and 5 (24%) had malignant tumors. Neurogenic tumors represented 57% of all tumors. Mean tumor size was of 6.7 cm (range, 3 to 11 cm). Six (29%) patients received adjuvant radiotherapy. Complications occurred in 6 (29%) patients, 4 (19%) of which were nervous injuries associated with peripheral nerve sheath tumors. Median disease-free follow-up survival was 33 months (range, 2 to 184 months) despite being an heterogeneous group of histologies. Parapharyngeal space is a rare location for head and neck tumors. Cervical approach should be the first choice for large tumors; transoral approach is reserved for tumors less than 3 cm. Conversion to mandibular swing approach when the cervical approach is not offering proper exposure for tumor resection is indicated. Preoperative histologic diagnosis is not required. Nevertheless, CT scan should always be performed in order to exclude paragangliomas, distinguish prestyloid from poststyloid lesions, and to assess the extension of the tumor as well as its relationship with adjacent structures.

Pediatric tumors of the parapharyngeal space: Three case reports and a literature review

Three cases of pediatric primary parapharyngeal space tumors, namely a Burkitt’s lymphoma, lipoblastoma and a ganglioneuroma are described here, along with a literature review. These disorders are very rare, accounting for less than 20% of all parapharyngeal neoplasms. In comparison to adults, there are differences in pathomorphologic spectrum of pediatric parapharyngeal tumors. The authors describe the prevalence of malignant tumors, mainly soft tissues sarcomas. The salivary gland tumors and paragangliomas which dominate in adult populations, are extremely rare in pediatric populations where the most common benign tumor to be encountered is that of neurogenic origin. It follows that these features modify the diagnostic and therapeutic approach.

Tumors and surgery of the parapharyngeal space.

The parapharyngeal space, an area of complex anatomic relationships, is involved in a wide variety of benign and malignant neoplasms. Because primary parapharyngeal space tumors are rare, it is difficult to obtain surgical experience in this region. This paper reviews the anatomy, presentation, evaluation, surgical approaches, and pathologic features and complications reported in managing patients with parapharyngeal space neoplasms. Two surgical procedures have been used by the author to treat 44 tumors in the parapharyngeal space. The cervical-parotid approach was used in 35 patients, and the cervical-parotid approach with midline mandibulotomy was used in 9 patients. Of the 44 tumors, 32 were benign lesions and 12 were malignant neoplasms. Forty tumors were primary parapharyngeal space tumors, and 4 cases represented isolated metastases to parapharyngeal nodes. Recurrent tumors accounted for 12 of the 44 cases. Discussion of the indications, surgical technique, and select points pertinent to using these two operative procedures is based on the operative experience gained from these 44 patients. The use of these two operations resulted in low morbidity and provided a safe, efficacious approach to the management of all parapharyngeal space neoplasms encountered.

Tumors and Surgery of the Parapharyngeal Space

The parapharyngeal space, an area of complex anatomic relationships, is involved in a wide variety of benign and malignant neoplasms. Because primary parapharyngeal space tumors are rare, it is difficult to obtain surgical experience in this region. This paper reviews the anatomy, presentation, evaluation, surgical approaches, and pathologic features and complications reported in managing patients with parapharyngeal space neoplasms.Two surgical procedures have been used by the author to treat 44 tumors in the parapharyngeal space. The cervical‐parotid approach was used in 35 patients, and the cervical‐parotid approach with midline mandibulotomy was used in 9 patients. Of the 44 tumors, 32 were benign lesions and 12 were malignant neoplasms. Forty tumors were primary parapharyngeal space tumors, and 4 cases represented isolated metastases to parapharyngeal nodes. Recurrent tumors accounted for 12 of the 44 cases. Discussion of the indications, surgical technique, and select points pertinent to using these two operative procedures is based on the operative experience gained from these 44 patients. The use of these two operations resulted in low morbidity and provided a safe, efficacious approach to the management of all parapharyngeal space neoplasms encountered.

Common tumors of the parapharyngeal space: refined imaging diagnosis.

Computed tomographic (CT) scans and magnetic resonance (MR) images in 103 patients with either a deep-lobe parotid tumor extending into the parapharyngeal space, a minor salivary gland tumor, a neuroma, or a paraganglioma were reviewed. The parotid or extraparotid nature of these masses was established by identifying a fat plane between the mass and the parotid gland. This was more reliably accomplished with MR imaging than with CT. Although dynamic CT allowed identification of the glomus tumors, MR imaging also permitted diagnosis of these lesions. The inherent CT and MR imaging characteristics of most of the neuromas and minor salivary gland tumors were indistinguishable. However, the neuromas tended to displace the internal carotid artery anteriorly, whereas the salivary lesions displaced this vessel posteriorly. This artery was better identified on MR images than on CT scans. Thus, these lesions, which are the four most common primary parapharyngeal space tumors, can be distinguished on MR images by evaluating not only their inherent signal characteristics but also the surrounding fat planes and any displacement of the internal carotid artery.