Abstract
Purpose
Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor’s radiological and clinical characteristics.
Materials and methods
Critical retrospective analysis of patients with PPS neoplasms who underwent surgery at our Institute. Data were collected on patient age and sex, tumor location and size, preoperative investigations, surgical approaches, histopathology, complications and outcomes.
Results
Between January 2000 and July 2015, 53 patients were treated at our Institute. Salivary gland tumors were the most common neoplasms followed by neurogenic tumors. CT scan/MRI were the most used preoperative imaging studies. The cervical approach with or without parotidectomy is the most used, providing the best compromise between the need for radicality and low risk of damage to the neurovascular structures. Mandibulotomy is used whenever the mass extends to the cranial base, assuming a higher morbidity, a slower functional recovery and the need for tracheotomy. Recently, TORS has been used for tumors of the PPS with promising outcomes.
Conclusions
PPS surgery includes a wide spectrum of approaches but it is still a matter of debate which one guarantees better functional and oncological outcomes. We report a surgical algorithm based on surgical invasiveness and tumor characteristics to standardize PPS tumors management. We also highlight the upcoming role of TORS in this field.
1
Introduction
The parapharyngeal space (PPS) is a region of the neck, described as an inverted pyramid from the skull base to the hyoid bone . It is divided by Riolan’s bundle into the pre- and post-styloid space . Tumors that develop in this region are rare, representing 0.5% of head-and-neck neoplasms . Salivary gland tumors are the most common, followed by neurogenic tumors of the post-styloid compartment . Surgical excision is the standard treatment . Computed tomography (CT) and magnetic resonance imaging (MRI) are fundamental to determine the extent of the lesion, to delineate its relationship to the carotid artery and to rule out any intracranial involvement . Angiography is recommended if paragangliomas or involvement of the carotid artery are suspected .
Different surgical approaches for PPS neoplasms have been reported (transoral/transoral robotic surgery or TORS, transcervical, parotidectomy or mandibulotomy) . Different key-points should be considered: radiologic investigations, good exposure of surgical field, preservation of the vital structures, minimal functional and esthetic impairment, suspicion of malignancy and surgical team experience .
We report fifteen years of experience of European Institute of Oncology (IEO) in PPS tumor treatment, introducing a surgical algorithm based on the advantages and limitations of each approach and their invasiveness. We aim to highlight the upcoming role of TORS, which has led to a reduction in more aggressive procedures.
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