Tumours of the Parapharyngeal Space

58 Tumours of the Parapharyngeal Space


• Characteristics


figure Arise from deep lobe of parotid or cranial nerves posterior to carotid sheath


figure Usually cause displacement of retromandibular portion of parotid regardless of intra- or extraparotid origin


figure Masses may grow silently to 4 to 5 cm


• Anatomy


figure Inverted pyramid bounded by layers of deep cervical fascia


figure Base is skull base


figure Apex is greater cornu hyoid


figure Lateral is fascia over mandible and medial pterygoids


figure Medial is fascia over superior constrictor


figure Divided into pre- and poststyloid spaces (Table 58.1)


• Presenting symptoms


figure Painless mass


figure Sore throat


figure Dysphonia


figure Dysphagia


figure Trismus


figure Nasal obstruction


figure Oral fullness


• Pathology


figure Reactive LNs


figure Metastases—lymphoma, NPC


figure Salivary (45%)—parotid/prestyloid salivary rests/minor salivary glands


figure Neurogenic (25%)—schwannoma, neurofibroma, neurosarcoma


figure Paragangliomas (chemodectomas)—glomus vagale, carotid body, glomus jugulare


• Diagnosis


figure CT scan


figure FNAC


figure Avoid open biopsy


• Surgical approaches to parapharyngeal space


figure Cervical


– Poor exposure superior


– Transverse incision level of hyoid


– SM gland reflected upwards


– Styloglossus and stylohyoid ligaments divided


– Parapharyngeal space is entered


– Indications: small extraparotid tumour, neural sheath tumours, carotid body tumours


figure Transparotid


– Perform superficial parotidectomy with full exposure of CN VII


– Indications: deep lobe parotid tumours


figure Cervicotranspharyngeal with midline mandibulotomy


– Maximum exposure


– Covering tracheostomy


– Lip-split


– ECA ligated

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Related posts:

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  4. Laryngeal Anatomy and Physiology

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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Tumours of the Parapharyngeal Space

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