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Stodulski D, Mikaszewski B, Witkowski P, Bartkowiak E, Pietruszewska W, Olejniczak I, Markowski J, Piernicka-Dybich A, Burduk P, Wierzchowska M, Czech J, Radomska K, Chańko A, Majszyk D, Bruzgielewicz A, Gazińska P, Wierzbicka M. The Clinical and Surgical Characteristics of Parotid Tumors with Parapharyngeal Space Involvement-A Multicenter Experience of the Polish Salivary Network. J Clin Med 2024; 13:4574. [PMID: 39124841 PMCID: PMC11313215 DOI: 10.3390/jcm13154574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/14/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Backgrounds/Objectives: Parotid gland tumors (PGTs) with parapharyngeal space (PPS) involvement have a specific clinical course and they can be a great challenge for surgeons, especially due to more difficult approaches and the risk of serious complications. The aim of this study is to present the characteristics of PGTs with PPS involvement. Methods: Retrospective, multicenter analysis of 1954 primary PGTs from 5 years (2017-2021) was performed. Comparative analysis was performed between groups with and without PPS involvement and included the following clinical and histopathological data: age, sex, place of residence, tumor size, FNAC result, percentage of malignant tumors, histological diagnosis, radicality of resection, and postoperative facial nerve (FN) dysfunction. Results: PPS involvement was found in 114 patients (5.83%). Secondary tumors affecting the deep lobe or the entire gland were predominant (46 and 60 cases, respectively). In a univariate analysis of tumors with and without PPS involvement, statistically significant differences were found in their size > 4 cm (12.97% vs. 37.72%), percentage of malignant tumors (7.12% vs. 17.55%), incidence of Warthin Tumors (WTs) (43.58% vs. 24.56%), percentage of R1 resection (5.53% vs. 12.50%), and rate of FN paresis (17.15% vs. 53.34%). Multivariate analysis showed that tumors with PPS involvement were statistically significantly characterized by larger size (tumors > 4 cm were 2.9 times more frequent), 2 times less frequent occurrence of WTs, and 1.6 times higher risk of FN paresis. Conclusion: PGTs with PPS involvement show certain clinical and histological differences and require more complex surgical accesses. Therefore, they cannot be treated as "ordinary" tumors occupying the deep lobe.
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Affiliation(s)
- Dominik Stodulski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Paweł Witkowski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Ewelina Bartkowiak
- Department of Otolaryngology and Laryngological Oncology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology, Head Neck Oncology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Izabela Olejniczak
- Department of Otolaryngology, Head Neck Oncology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Jarosław Markowski
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Aleksandra Piernicka-Dybich
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 87-100 Bydgoszcz, Poland
| | - Małgorzata Wierzchowska
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 87-100 Bydgoszcz, Poland
| | - Joanna Czech
- Department of Otolaryngology, Phoniatrics and Audiology, Collegium Medicum, Nicolaus Copernicus University, 87-100 Bydgoszcz, Poland
| | - Katarzyna Radomska
- Department of Otolaryngology, Pomeranian University of Medicine, 70-204 Szczecin, Poland
| | - Alicja Chańko
- Department of Otolaryngology, Pomeranian University of Medicine, 70-204 Szczecin, Poland
| | - Daniel Majszyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Antoni Bruzgielewicz
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Patrycja Gazińska
- Biobank Research Group, Lukasiewicz Research Network—PORT Polish Center for Technology Development, 54-066 Wroclaw, Poland
- Research Oncology, Division of Cancer Studies, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9RT, UK
| | - Małgorzata Wierzbicka
- Department of Otolaryngology, Regional Specialist Hospital Wroclaw, Research & Development Centre, 51-124 Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland
- Institute of Human Genetics, Polish Academy of Sciences, 01-447 Poznan, Poland
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Galli A, Giordano L, Mattioli F, Serafini E, Fermi M, Bramati C, Bussi M. The transcervical-transparotid corridor for management of parapharyngeal space neoplasms: strengths and limits in a bi-institutional retrospective series. Eur Arch Otorhinolaryngol 2024; 281:897-906. [PMID: 37768370 DOI: 10.1007/s00405-023-08256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND PURPOSE Parapharyngeal space (PPS) neoplasms represent 1% of all head and neck tumors and are mostly benign. Surgery is the mainstay of treatment and the transcervical-transparotid (TC-TP) corridor still represents the workhorse for adequate PPS exposure. Our series investigates strengths and limits of this approach on a multi-institutional basis. METHODS We reviewed consecutive patients submitted to PPS surgery via TC-TP route between 2010 and 2020. Hospital stay, early and long-term complications, and disease status were assessed. RESULTS One hundred and twenty nine patients were enrolled. Most tumors were benign (79.8%) and involved the prestyloid space (83.7%); the median largest diameter was 4.0 cm. The TC-TP corridor was used in 70.5% of patients, while a pure TC route in about a quarter of cases. Early postoperative VII CN palsy was evident in 32.3% of patients, while X CN deficit in 9.4%. The long-term morbidity rate was 34.1%, with persistent CN impairment detectable in 26.4% of patients: carotid space location, lesion diameter and malignant histology were the main independent predictors of morbidity. A recurrence occurred in 12 patients (9.4%). CONCLUSIONS The TC-TP corridor represents the benchmark for surgical management of most of PPS neoplasms, though substantial morbidity can still be expected.
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Affiliation(s)
- Andrea Galli
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - Leone Giordano
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Mattioli
- Dept. of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Edoardo Serafini
- Dept. of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo, 71, 41125, Modena, Italy
| | - Matteo Fermi
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Via Giuseppe Massarenti, 9, 40138, Bologna, Italy
| | - Chiara Bramati
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Mario Bussi
- Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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De Luca P, Atturo F, Tombolini M, Colangeli R, Simone M, De Seta D, de Campora L, Tassone D, Camaioni A. Parapharyngeal space tumors: a twenty-year single-center retrospective analysis on the effectiveness of transcervical and transoral approaches on local control and disease-specific survival. Am J Otolaryngol 2023; 44:103741. [PMID: 36566674 DOI: 10.1016/j.amjoto.2022.103741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/31/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To retrospectively analyzed our twenty-years single-center experience in the treatment of PPS tumors, focusing on the selection of surgical approach and the survival outcome. METHODS Tumors involving the PPS between January 2000 and February 2022 were retrospectively included. The surgical approach was dictated by the localization of the tumor, its dimensions, the relation to anatomic structures and its etiology. RESULTS 34 patients were included in the study. The median age was 50.5 yr, with a gender female prevalence. Most tumors were benign and non recurrent. 20 tumors were treated through lateral approach (transcervical or transcervical-transparotid), 11 through medial approach (transoral), and only 3 tumors were approached by multiple corridors. The 5 years disease free survival (DFS) was 78.8 % (CI 78-79.3 %). CONCLUSIONS In our experience, the transcervical and transoral approaches can be considered the ideal surgical approach to manage tumors of PPS, especially in cases of benign neoplasms.
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Affiliation(s)
- Pietro De Luca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy; Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy.
| | - Francesca Atturo
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Mario Tombolini
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Roberta Colangeli
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Matteo Simone
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Daniele De Seta
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Luca de Campora
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Domenico Tassone
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Angelo Camaioni
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Rome, Italy
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Li L, Xu H, London NR, Carrau RL, Jin Y, Chen X. Endoscopic transoral approach to the lateral poststyloid space. Head Neck 2023; 45:294-301. [PMID: 36333984 DOI: 10.1002/hed.27240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/10/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022] Open
Abstract
The lateral poststyloid space (LPSS) located at the posterolateral aspect of the styloid process. This study aims to explore the anatomical relationships in LPSS via a transoral corridor, providing reference for addressing lesions extending to this region. An endoscopic transoral approach for exposure of the LPSS was performed on 6 cadaveric specimens (12 sides). Related landmarks were explored, and transoral extirpation of tumors extended into LPSS was employed in 12 patients. The deep lobe of the parotid gland, extratemporal facial nerve, and the accompanying artery in the LPSS were sufficiently exposed via the transoral corridor in all 12 cadaveric sides. The transoral corridor provided adequate exposure for tumors extending to the LPSS, and en bloc resection was achieved in these 12 patients. No facial nerve or vascular injury occurred, and no recurrence observed in this cohort with an average follow-up of 26 months. An endoscopic transoral approach provides a direct access to the LPSS. Appreciation of the anatomical relationships within the LPSS is valuable for employing a transoral extirpation of tumors extending to this specific region.
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Affiliation(s)
- Lifeng Li
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hongbo Xu
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nyall R London
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Yonggang Jin
- Department of Otolaryngology - Head and Neck Surgery, Xianghe People's Hospital, Langfang, China
| | - Xiaohong Chen
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Hornung B, Constantinidis J, Thimsen V, Agaimy A, Koch M, Gostian AO, Sievert M, Müller SK, Iro H, Mantsopoulos K. Pleomorphic Adenoma of the Parotid Gland and the Parapharyngeal Space: Two Diametrically Opposing Surgical Philosophies for the Same Histopathologic Entity? J Clin Med 2021; 11:142. [PMID: 35011883 PMCID: PMC8745468 DOI: 10.3390/jcm11010142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the histopathologic findings in parotid and parapharyngeal pleomorphic adenomas and draw conclusions concerning the surgical strategy. METHODS Retrospective study of medical charts of patients with resected pleomorphic adenomas (PA) between 2005 and 2020 at two tertiary medical referral centers. Histologic specimens were reexamined by an experienced head and neck pathologist. Patients with insufficient/incomplete data were excluded from our study sample. RESULTS A total of 844 patients formed our study sample (291 men, 553 women, average age 48.9 years); 786 cases had a PA in the parotid gland (PG) (93.1%), and the remaining 58 cases had a PA in the parapharyngeal space (PS) (6.9%). Recurrences were detected in 8/844 cases (7/786 in the PG, 1/58 in the PS, 0.94% in total) with a mean follow-up time of 86.7 months (10-189 months) with no statistically significant differences between the study groups (p = 0.527). Our analysis showed that parapharyngeal pleomorphic adenomas are characterized by a lower incidence of an intact anatomical capsule (71.4% vs. 82.6%, p = 0.035) and a remarkably more frequent occurrence of satellite nodules (20.7% vs. 7.5%, p < 0.001). CONCLUSIONS The more challenging histopathologic profile of parapharyngeal pleomorphic adenomas points towards the fact that parapharyngeal surgery should remain in the hands of experienced surgeons at high-volume centers.
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Affiliation(s)
- Benita Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Jannis Constantinidis
- 1st Deparment of ORL, Head & Neck Surgery, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Vivian Thimsen
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Sarina Katrin Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (B.H.); (V.T.); (M.K.); (A.-O.G.); (M.S.); (S.K.M.); (H.I.)
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