Primary Pathology of the Parapharyngeal Space

Endoscopic-Assisted Pterygomandibular Approach for Parapharyngeal Tumor Resection: A Case Series

BACKGROUND

The endoscope-assisted pterygomandibular ligament approach for the resection of parapharyngeal space (PPS) tumors has been reported in a limited number of cases, with insufficiently detailed procedural descriptions.

PURPOSE

The study purpose was to report clinically relevant outcomes among patients who underwent endoscopy-assisted pterygomandibular ligament resection for PPS tumors.

STUDY DESIGN, SETTING, AND SAMPLE

This study was a retrospective case series analyzing patients treated between January 2018 and July 2021 at the Department of Otolaryngology, Second Affiliated Hospital of Wenzhou Medical University. The sample consisted of patients who underwent endoscopy-assisted pterygomandibular ligament resection for PPS tumors. Patients with incomplete medical records or loss of follow-up were excluded.

MAIN OUTCOME VARIABLE

The primary outcomes included successful tumor resection, intraoperative blood loss, operation duration, hospital stay, complications, recurrence, and follow-up duration.

COVARIATES

Demographic characteristics, tumor size, pathology, postoperative pain score were collected and analyzed.

ANALYSES

Data were summarized using descriptive statistics.

RESULTS

The sample was composed of 9 patients (4 males, 5 females). The operation time ranged from 30 to 240 minutes, with operation blood loss between 5 and 200 mL. The average length of hospital stay was 8.45 days. The average pain score at the first postoperative day was 3.5. No complications, such as infection, bleeding, or nerve damage, were observed. No tumor recurrence was detected over a median follow-up of 53 months (interquartile range: 32.5).

CONCLUSION

The endoscope-assisted pterygomandibular ligament internal approach appears to be a good strategy for PPS tumor resection.

Parapharyngeal space metastasis from squamous cell carcinoma: indications and limits of different surgical approaches

PURPOSE OF REVIEW

The aim of this review is to investigate the most suitable surgical approach to managing parapharyngeal space (PPS) squamous cell carcinoma (SCC) metastasis.

RECENT FINDINGS

SCC metastasis in PPS are extremely rare. The PPS itself is a complex anatomical area, requiring extensive surgical experience and various surgical approaches for effective management. Several authors have attempted to systematize the surgical approaches to the PPS based on the anatomical location and histological nature of the lesions. However, there are currently few studies in the literature on the specific management of SCC metastases in the PPS, as these lesions are extremely rare.

SUMMARY

The treatment of SCC metastases in the PPS must be determined based on the individual patient. If the patient is a candidate for surgery, the surgical approach should be chosen based on the location of the metastases and must ensure a sufficiently wide surgical corridor to allow for as complete a resection as possible. To date, the surgical approach that best meets these requirements is the transcervical transparotid approach. With new technologies, including the use of robotics and endoscopy, surgery can become increasingly less invasive while maintaining the wide exposure provided by open surgical procedures.

Ultrasound-guided diagnosis on a parapharyngeal mass

Masses in the parapharyngeal area are rare and often due to infectious phenomena arising from the oral cavity or pharynx which lead to abscess formation. Less frequently, the lesion can be neoplastic. Tumours of the parapharyngeal space are rare, accounting for less than 1% of all head and neck neoplasms. We report the case of a patient who came to our observation for mandibular pain. Multiparametric diagnostic imaging was done thus showing a parapharyngeal mass. An ultrasound guided biopsy was performed by a transcutaneous route with a high median approach at neck level, to characterize the mass in the right tonsillar region. The histological examination reported the final histological diagnosis of sarcomatoid carcinoma.

Approaches to Parapharyngeal Space and Infratemporal Fossa Based on Different Anatomical Spaces

OBJECTIVES

The parapharyngeal space (PPS) and infratemporal fossa (ITF) present significant challenges for endoscopic skull base surgery due to their complex anatomy and lack of clear bony landmarks. This study aims to propose a systematic compartmentalization of the PPS and ITF, based on key anatomical structures, to optimize surgical planning and approaches.

METHODS

To retain a precise bony reference framework, the walls of the maxillary sinus and pterygoid bone were preserved. Anatomical dissection was conducted along muscular planes, dividing the region into 3 spaces. The feasibility and applicability of the proposed compartmentalization were evaluated through cadaveric studies and verified in clinical cases.

RESULTS

The PPS and ITF were classified into 3 distinct spaces based on the positioning and orientation of the medial pterygoid, lateral pterygoid, levator veli palatini, and stylopharyngeus muscles. The first space is located anterior to the pterygoid muscles, the second lies between the pterygoid muscles and the levator veli palatini/stylopharyngeus, and the third is posterior to these latter muscles. Among 24 clinical cases reviewed, 3, 8, and 13 lesions were situated in the first, second, and third spaces, respectively. Surgical outcomes were favorable, with complete lesion resection and no intraoperative or postoperative complications observed.

CONCLUSIONS

A three-space model of the PPS and ITF, defined by specific muscle planes, provides a structured framework to guide endoscopic skull base approaches. This model allows for targeted selection of surgical routes based on lesion location and its relationship with the internal carotid artery, aiming to minimize procedural risks.

Meningocele in the Parapharyngeal Space: A Case Report and Review of the Literature

The parapharyngeal space has been described as an inverted pyramid shape with the base of the skull and the great cornu of the hyoid bone at the top. Tumors of the parapharyngeal space account for 0.5% of head and neck tumors and a wide range of tumor types can occur in this area, 80% of which are benign, the most common being pleomorphic adenomas of the salivary glands and neurogenic tumors. We present a 39-year-old woman who was hospitalized due to left-sided neck pain with a feeling of blockage in the left ear and hearing loss for 10 months. Imaging showed that the mass was not connected to the cranium and the patient underwent surgical resection via a transoral approach, where the contents of the mass were found to be cerebrospinal fluid, and meningocele in the parapharyngeal space is a rare occurrence. The patient presented mainly with painful symptoms, which were eventually relieved by nerve block therapy.