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Shanmugam S, Susikar S, Vijayalakshmi G. Parapharyngeal Space Tumors-What Lies in This Hidden Space? Indian J Otolaryngol Head Neck Surg 2023; 75:3847-3849. [PMID: 37974755 PMCID: PMC10645770 DOI: 10.1007/s12070-023-03551-5] [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: 07/14/2022] [Accepted: 01/30/2023] [Indexed: 11/19/2023] Open
Abstract
The parapharyngeal or the lateral pharyngeal space is a potential anatomical space in the lateral neck extending from skull base to the hyoid bone. The fascial attachment between the styloid process and tensor veli palatini muscle divides this space into two compartments - pre styloid and post styloid. Primary tumors arising from this hidden space are quite rare and demand reasonable doubts and advanced surgical expertise in management. We describe our experience in managing these tumors and the varied surgical approaches.
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Affiliation(s)
- Subbiah Shanmugam
- Department of Surgical Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu India
| | - Sujay Susikar
- Department of Surgical Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu India
| | - G. Vijayalakshmi
- Department of Surgical Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu India
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Dabas S, Menon NN, Ranjan R, Gurung B, Shukla H, Sharma AK, Tiwari S, Sinha A, Bhatti SS, Sangal R. Transoral robotic surgery for adult parapharyngeal lymphangioma: A case report. World J Otorhinolaryngol 2023; 10:23-29. [DOI: 10.5319/wjo.v10.i2.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/17/2022] [Accepted: 02/09/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children. The most common sites of presentation is the head and neck region, less commonly seen in axilla, chest, liver, spleen, etc. The ideal modality of treatment has always been surgical excision irrespective of the site and age group. But with the advent of minimally invasive surgical techniques, it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.
CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside, where Transcervical approach was attempted to remove the parapharyngeal mass, but failed. Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass. He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.
CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature. The symptoms of the patient with large parapharyngeal mass include dysphagia, dyspnoea and neck swelling. Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor. With the advent of robotics in oncology, transoral robotic excision is one of the best approaches to perform such a surgery.
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Affiliation(s)
- Surender Dabas
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Nandini N Menon
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Reetesh Ranjan
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Bikas Gurung
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Himanshu Shukla
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Ashwani K Sharma
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Sukirti Tiwari
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | - Ajit Sinha
- Department of Surgical Oncology, BLK MAX Superspeciality Hospital, Delhi 110007, India
| | | | - Rishu Sangal
- Department of Radiology, BLK MAX Superspeciality Hospital, Delhi 110007, India
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Meliante PG, Colizza A, Ralli M, Minni A, Angeletti D, Cambria F, de Vincentiis M. Treatment of relapses of benign latero-cervical pathology: a narrative literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S76-S83. [PMID: 37698104 PMCID: PMC10159646 DOI: 10.14639/0392-100x-suppl.1-43-2023-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 09/13/2023]
Abstract
Benign laterocervical pathologies are not without pitfalls. Many may relapse after many years and, sometimes, they cannot be predicted. The purpose of this review is to describe the surgical measures necessary for the treatment of relapses of the most common benign laterocervical masses. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials databases for articles describing the treatment of the most common benign cervical disease recurrences, and summarised available evidence in this narrative review. We overviewed observations about recurrent benign mixed tumour (pleomorphic adenoma), parapharyngeal space tumours and carotid body paragangliomas, thyroglossal duct anomalies and branchial cleft anomalies. Proper surgical technique is crucial for safely and effectively managing the relapses of benign latero-cervical diseases. Radiotherapy is indicated in several cases of recurrence such as pleomorphic adenoma and unresectable paraganglioma. Long-term follow-up is of utmost importance to promptly recognise and treat recurrencies.
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Affiliation(s)
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Motta G, Testa D, Donadio A, Ricciardiello F, Cavaliere M, Massimilla EA, Motta G. Transoral Approach to Parapharyngeal Space Tumours: Preliminary Reports from a Single-Centre Retrospective Analysis. Curr Oncol 2023; 30:3927-3939. [PMID: 37185410 PMCID: PMC10136736 DOI: 10.3390/curroncol30040297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Purpose: The aim of this study is to identify certain parapharyngeal space tumours with specific characteristics that can be treated successfully through an endoscopically assisted transoral approach (EATA). Methods: Nine patients with PPS tumours underwent surgery through an EATA between 2003 and 2021. All patients underwent clinical examination and fibrolaryngoscopy. Preoperative CT and/or MRI was performed on all patients. Results: All the patients were successfully treated through an endoscopically assisted transoral approach. Histological examination revealed five pleomorphic adenomas, two schwannomas, one ectopic thyroid gland and one lipoma. The only long-term sequelae observed was Horner syndrome in the two schwannomas arising from the carotid space. The mean hospitalisation time was 2.6 days, while the mean follow-up time was of 9.7 years. Conclusions: An endoscopically assisted transoral approach (EATA) is a valid technique for treating benign capsulated tumours of the true PPS and some benign capsulated tumours of the superomedial aspect of the carotid space.
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Affiliation(s)
- Giovanni Motta
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Domenico Testa
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Anna Donadio
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | | | - Michele Cavaliere
- Otorhinolaryngology-Head and Neck Surgery Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80138 Naples, Italy
| | - Eva Aurora Massimilla
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Gaetano Motta
- ENT Unit-Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80131 Naples, 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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Parapharyngeal Space Tumors: Our Experience. J Pers Med 2023; 13:jpm13020283. [PMID: 36836517 PMCID: PMC9962679 DOI: 10.3390/jpm13020283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Para-pharyngeal space (PPS) tumors include an heterogeneous group of neoplasms, accounting for approximatively 0.5-1.5% of all head and neck tumors. Management of these neoplasms requires a careful diagnostic workout and an appropriate surgical approach to obtain good outcomes associated with minimal aesthetic drawbacks. In this study we investigated clinical onset, histologic features, surgical treatment outcomes, peri operative complications and follow up of 98 patients treated for PPS tumors in our Centre between 2002 and 2021. Furthermore, we reviewed our preliminary experience of preoperative embolization of hyper vascular PPS tumors trough SQUID12, an ethylene vinyl alcohol copolymers (EVOH) which exhibits many advantages over other embolic agents, due to its better devascularization rate and lower risk of systemic complications. Our data support the hypothesis that transoral surgery scenario should be significantly revised, as it could represent a valid treatment for tumors located in lower and prestyloyd portion of PPS. Moreover, SQUID12, a novel embolization agent, may be a very promising choice for PPS hyper vascularized tumors, ensuring higher devascularization rate, safer procedures and lower risk of systemic dispersion compared to traditional Contour treatment.
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Wu C, Xu C, Lau H, Shi X, Liu Q, Zhou L, Tao L. Transnasal drainage prevents surgical cavity related complications in transoral robotic surgery resected parapharyngeal space tumors. Acta Otolaryngol 2023; 143:91-99. [PMID: 36639142 DOI: 10.1080/00016489.2023.2165710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is no evidence about the relationship between surgical cavity drainage and related postoperative complications in transoral robotic surgery (TORS) resected parapharyngeal space (PPS) tumors. OBJECTIVES To investigate the clinical efficacy and advantage of transnasal PPS drainage to prevent surgical cavity related complications (SCRC) in TORS resected PPS tumors. MATERIAL AND METHODS Twenty-three patients undergoing TORS for PPS tumors were identified. In the experimental group (EG, 8 patients), the surgical incision was sutured directly and the transnasal drainage tube was placed. In the control group (CG, 15 patients), the surgical incision was partially sutured without drainage. The healing grade of surgical incision (HGSI), healing grade of surgical cavity (HGSC), SCRC, and other complications were compared. RESULTS There were significant statistical differences in postoperative clinical rehabilitation indexes (HGSI/HGSC/SCRC) between the two groups. The comparison results of HGSI and HGSC in the two groups (EG vs CG) were (100% vs 66.7%) and (100% vs 46.7%) respectively. Compared with the EG, eight cases (53.3%) in the CG had postoperative SCRC such as hemorrhage, effusion, and swollen. CONCLUSIONS AND SIGNIFICANCE For TORS resected PPS tumors, transnasal PPS drainage is an effective and comfortable method to improve postoperative HGSI and HGSC and prevent SCRC.
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Affiliation(s)
- Chunping Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Chengzhi Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Huiching Lau
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Xiaoling Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Quan Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology Head and Neck Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.,Shanghai Key Clinical Disciplines of Otorhinolaryngology, Shanghai, China
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Zhu X, Shi X, Zhou L, Zhang M, Cheng L, Shi Y, Xu C, Wu C, Liu Q, Cao P, Tao L. Trends in the surgical management of parapharyngeal space tumors: A single-center retrospective analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:47-54. [PMID: 36089451 DOI: 10.1016/j.ejso.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Surgery remains the mainstay treatment for parapharyngeal space (PPS) tumors. Given the rapid advance and increasing usage of endoscopic and robotic techniques, we aimed to investigate the surgical trends of PPS tumors in our institution and analyze their impact on patients' treatment outcomes. MATERIALS AND METHODS All patients who underwent surgical resection of PPS tumors from 2014 to 2021 at the Eye, Ear, Nose, and Throat Hospital of Fudan University were retrospectively reviewed. Student's t-test, Chi-square test, and multinomial logistic regression analyses were used to compare the surgical outcomes between groups. RESULT Of the included 389 patients, the recipients of endoscopic surgery have largely increased in our center, with 17 of 134 cases (12.7%) in the group 2014-2017 and 187 of 255 cases (73.3%) in the group 2018-2021. The use of transoral and trans-nasal approaches increased in recent years (5.2% in 2014-2017 vs. 26.0% in 2018-2021), while that of trans-mandibular and lateral skull base approaches decreased (5.9% in 2014-2017 vs. 0.8% in 2018-2021). Decreased blood loss of operation and decreased risks of postoperative neurovascular complications were observed in the group 2018-2021. Similar findings were observed among patients receiving endoscopic surgery when compared with those receiving conventional surgery. CONCLUSION In our institution, the overall trends in the surgical management of PPS tumors moved towards minimally invasive approaches with the assistance of endoscopy or surgical robots. The two surgical techniques were feasible and safe, and to a great extent, contributed to the improved surgical outcomes we observed in recent years.
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Affiliation(s)
- Xiaoke Zhu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Xiaoling Shi
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Liang Zhou
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Ming Zhang
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Lei Cheng
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Yong Shi
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Chengzhi Xu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Chunping Wu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Quan Liu
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China
| | - Pengyu Cao
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China.
| | - Lei Tao
- Department of Otolaryngology, Shanghai Key Clinical Disciplines of Otorhinolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, PR China.
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Faisal M, Seemann R, Fischer G, Lill C, Hamzavi S, Wutzl A, Erovic BM. Neurological Complications in Benign Parapharyngeal Space Tumors - Systematic Review and Meta-Analysis. Int Arch Otorhinolaryngol 2022; 27:e158-e165. [PMID: 36714902 PMCID: PMC9879647 DOI: 10.1055/s-0042-1744164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/16/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Parapharyngeal space tumors with complex anatomy and diverse histology have remained a challenging phenomenon for treating physicians. Objectives We have conducted a comprehensive web search on the PubMed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM), and Clinicaltrials.gov databases to determine the factors that are associated with postoperative complications in parapharyngeal space tumors. Data Synthesis Two researchers reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. The systematic review has identified 631 benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies, with a mean age of 42.9 ± 7.76 years old and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement, and proximity to great vessels or to the skull base were the deciding factors in selecting the surgical approach. The factors considered to select the surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae ( p = 0.106). Tumors with neurogenic histology have significantly increased chances of developing neurological complication (OR 6.07; p = 0.001). Conclusion Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.
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Affiliation(s)
- Muhammad Faisal
- Shaukat Khanum Memorial Cancer Hosital and Research Centre, Lahore, Pakistan,Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria,Address for correspondence Muhammad Faisal, BDS, FCPS (OMFS), FHNS (AT) Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre7-A, Block R3, Johar Town, Lahore, Pakistan
| | - Rudolf Seemann
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Gregor Fischer
- Department of ENT, Danube University, Krems Faculty of Health and Medicine, Krems, Niederösterreich, Austria
| | - Claudia Lill
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Sasan Hamzavi
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Arno Wutzl
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
| | - Boban M. Erovic
- Department of Head and Neck Surgery, Evangelisches Krankenhaus Vienna, Vienna, Austria
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Orlando P, Locatello LG, Gallo O, Leopardi G, Maggiore G. Endoscopy‐assisted transoral approach for parapharyngeal space tumors: Our experience and a systematic review of the literature. World J Otorhinolaryngol Head Neck Surg 2022; 9:79-90. [PMID: 37006749 PMCID: PMC10050965 DOI: 10.1002/wjo2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Several approaches have been described for the excision of parapharyngeal space tumors (PPSTs). Advances in endoscopy gave a further stimulus to the use of the transoral route. Aims We present our experience with the endoscopy-assisted transoral approach (EATA) in this regard and a review of the most recent literature about EATA for PPSTs excision. Materials and Methods We retrospectively analyzed our experience and systematically reviewed the literature about the outcomes of this technique. Results Seven PPSTs were completely excised, with three of them requiring a combined transcervical approach. Only one case of postoperative wound dehiscence was registered, and the mean length of stay was 3.9 days. Final histopathological examination confirmed the results obtained with preoperative fine-needle aspiration biopsy in all cases and no recurrences were apparent after a mean follow-up of 28.1 months. Discussion Magnetic resonance imaging, the modified Mallampati score and the 8 Ts criteria are useful instruments for the choice of the most appropriate surgical approach. Conclusion In light of our experience and following other published series in the literature, we believe that EATA may represent a safe and effective approach for the treatment of the majority of PPSTs.
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Affiliation(s)
- Pietro Orlando
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology Careggi University Hospital Florence Italy
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
| | - Gianluca Leopardi
- Unit of Otorhinolaryngology Azienda USL Toscana Centro, San Giuseppe Hospital Empoli Italy
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Shankar R, Mishra A, Malik A. Role of Robotics in Non-oropharyngeal Head and Neck Tumours. Indian J Surg Oncol 2022; 13:436-442. [DOI: 10.1007/s13193-022-01526-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/21/2022] [Indexed: 10/19/2022] Open
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12
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Joshi P, Joshi KD, Nair S, Bhati M, Nair D, Bal M, Joshi A, Mummudi N, Tuljapurkar V, Chaukar DA, Chaturvedi P. Surgical Management of Parapharyngeal Tumors: Our Experience. South Asian J Cancer 2021; 10:167-171. [PMID: 34938679 PMCID: PMC8687863 DOI: 10.1055/s-0041-1731580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context
Tumors of parapharyngeal space (PPS) are rare and histologically diverse. The management of these tumors requires diligent assessment and planning with due consideration of various anatomical and pathological aspects of the lesion.
Aims
This retrospective study aims to present our experiences in the clinical and pathological aspects of PPS tumors with a critical evaluation of management.
Settings and Design
Retrospective analytical study.
Methods and Material
The electronic medical records of 60 cases of PPS tumors, managed surgically from 2007 to 2017, were reviewed and analyzed using SPSS 22 software. The mean follow-up duration was 44 months.
Results
The mean age was 45 years with a male-to-female ratio of 1.7 (38:22). The majority of the tumors were benign (71.7%) and the most common presentation being upper neck mass or oropharyngeal mass. Histologically, neurogenic tumors were most common (43.3%) PPS tumors, followed by tumors of salivary gland origin. Magnetic resonance imaging was used as a diagnostic modality in 70% of cases, and computed tomography scan and positron emission tomography/CT were used in 26.7 and 3.3% of cases, respectively. In our study, the diagnostic accuracy of fine-needle aspiration cytology was 71% for benign and 47% for malignant lesions. The most common approach for surgery used was transcervical (72%).
Conclusion
The study reveals that cranial nerve palsy is the most common complication associated with PPS tumors. Completely resected, malignant tumors originating within PPS have a good prognosis, as compared with tumors extending or metastasized to PPS.
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Affiliation(s)
- Poonam Joshi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kamal Deep Joshi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Muddasir Bhati
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vidisha Tuljapurkar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Devendra A. Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Virós Porcuna D, Pardo Muñoz L, Viña Soria C, Nicastro V, Palau Viarnès M, Pollán Guisasola C. A retrospective analysis of surgery in prestyloid parapharyngeal tumors: Lateral approaches vs transoral robotic surgery. Laryngoscope Investig Otolaryngol 2021; 6:1062-1067. [PMID: 34693001 PMCID: PMC8513456 DOI: 10.1002/lio2.662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Surgery is the standard treatment for most tumors in the prestyloid parapharyngeal space (PPS) but it can be a challenging procedure because of the anatomical complexity of the area. Prestyloid surgery can be performed with various lateral approaches or with a medial approach using transoral robotic surgery (TORS)-either alone or in combination with a transcervical incision. We have retrospectively compared our center's results with lateral and medial approaches. METHODS Between 2015 and 2020, 28 patients with prestyloid PPS tumors underwent surgery at our center: 14 with lateral approaches, including transcervical, transcervical-parotid, and transcervical-mandibular, and 14 with medial approaches (12 with TORS and two with TORS plus a transcervical incision). We compared surgical time, postsurgical complications, length of hospital stay, need for feeding tube, and relapse-free survival in the two patient groups. RESULTS Pleomorphic adenoma was the most frequent tumor and 60.7% of the tumors were benign. Tumor volume and maximum length were similar in the two groups of patients. Intraoperative image guidance and ultrasound were used in 33% of TORS. TORS was associated with less surgical time, fewer complications, and shorter hospital stays. Recurrence rates were similar in the two groups. CONCLUSION The medial approach by TORS offers superior results in prestyloid tumors than the open lateral approach and can be refined by intraoperative guidance. Level of Evidence: 4.
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Affiliation(s)
- David Virós Porcuna
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Laura Pardo Muñoz
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Constanza Viña Soria
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Viviana Nicastro
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
| | - Mar Palau Viarnès
- Otolaryngology Section, Head and Neck SurgeryHospital Germans Trias i PujolBadalonaSpain
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14
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Fermi M, Serafini E, Ferri G, Alicandri-Ciufelli M, Presutti L, Mattioli F. Management of parapharyngeal space tumors with transparotid-transcervical approach: analysis of prognostic factors related with disease-control and functional outcomes. Eur Arch Otorhinolaryngol 2021; 279:2631-2639. [PMID: 34529157 DOI: 10.1007/s00405-021-07074-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Different therapeutic strategies have been developed to improve surgical and functional outcome of parapharyngeal space (PPS) neoplasms. The transparotid-transcervical approach (TTa) is a valid surgical option to manage most PPS tumors. Its short- and long-term disease control and cranial nerve (c.n.) function outcomes have not been discussed extensively. METHODS All patients who underwent TTa over a 10-year period at a tertiary academic center were retrospectively reviewed. Data about preoperative imaging, clinical presentation, tumor's size, location and histology, and postoperative oncological and functional results were registered and analyzed. RESULTS Sixty patients matched the inclusion criteria. Most of the lesions were benign (71.7%), involved the prestyloid PPS (63.3%) and measured more than 30 mm (75%). Fifty-two (86.7%) lesions were resected en-bloc. Clear margins were achieved in 91.7% of the cases, with positive margins solely associated with malignancy (p = 0.008). Post-operative c.n. function was satisfactory, with X c.n. function significantly associated with the retrostyloid location (p = .00) and neurogenic tumors (p = 0.02). Local disease-control was achieved in 96% of the cases after a median follow-up of 46 (± 19.7-82.0 IQR) months. CONCLUSIONS The TTa was safe and effective, achieving a satisfactory local control rate. Nevertheless, malignancies maintain a higher rate of positive margin due to their infiltrative nature and the complex anatomy of the PPS. In such cases, multiportal approaches might be more effective. However, post-operative c.n. function remained satisfactory, irrespective of lesions' size and histopathologic behavior. A higher X c.n. deficit rate was observed in retrostyloid and neurogenic lesions.
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Affiliation(s)
- Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy.,Department of Specialist, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Edoardo Serafini
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy.
| | - Gaetano Ferri
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy
| | - Matteo Alicandri-Ciufelli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy.,Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Francesco Mattioli
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital of Modena, Via del pozzo 71, 41124, Modena, Italy
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15
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Abstract
Transoral excision of parapharyngeal space (PPS) tumors has increased in popularity along with the increased use of robotic and endoscopic surgical technology. Here, the authors highlight the indications, techniques, outcomes, and complications of transoral approaches to PPS tumors, with a special emphasis on salivary tumors of the PPS and the transoral robotic surgery approach.
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16
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Fiedler LS. Management of a prestyloid parapharyngeal first branchial cleft cyst from puncture to surgical excision and how a routine procedure can turn into an emergency. BMJ Case Rep 2021; 14:14/1/e238727. [PMID: 33436361 PMCID: PMC7805352 DOI: 10.1136/bcr-2020-238727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The anatomy of the parapharyngeal space (PPS) is complex and the differential diagnosis of tumours in this area broad. Although primary tumours of the PPS account for only 0.5% of head and neck neoplasms and are benign lesions in 80% of the cases, the surgical management is crucial and needs specific planning and evaluation of CT and/or MRI scans. In literature, there are several ways to surgically deal with PPS tumours and due to location and differentiation, can reach from transparotid, submandibular transcervical and transoral approaches, extending in a mandibulotomy, further radiotherapy. Parapharyngeal cleft cysts are extremely rare and their management can be complex. We describe the presentation, the diagnosis and further management of a 71-year-old woman with a 6 cm first branchial cleft cyst in the PPS from puncture over emergency tracheostomy to elective excision via a combined transcervical/transparotid and transoral approach. We highlight the importance of the differential diagnosis and the and the correct clinical management of this rare entity.
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Affiliation(s)
- Lukas S Fiedler
- Otorhinolaryngology and Head and Neck Surgery, Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier, Deutschland, Germany
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17
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BAYRAM A, ESKİİZMİR G, CİNGİ C, HANNA E. Robotic Surgery in Otolaryngology-Head and Neck Surgery: Yesterday, Today and Tomorrow. ENT UPDATES 2020. [DOI: 10.32448/entupdates.780604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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18
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Lim JY, Park YM, Kang MS, Kim DH, Choi EC, Kim SH, Koh YW. Comparison of Surgical Outcomes of Robotic and Conventional Approaches in Patients with Pre- and Poststyloid Parapharyngeal Space Tumors. Ann Surg Oncol 2020; 27:4535-4543. [PMID: 32474818 DOI: 10.1245/s10434-020-08536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Benefits and drawbacks of robotic surgical approaches for parapharyngeal space (PPS) tumors remain undetermined. The purpose of this study is to compare surgical outcomes of PPS tumor patients who underwent robotic surgery with those of patients who received conventional surgical treatment. PATIENTS AND METHODS We retrospectively analyzed clinicopathologic data from 136 patients who underwent surgical removal of PPS tumors via conventional or robotic approaches. RESULTS We identified PPS tumors in pre- and poststyloid regions in 87 (64%) and 49 (36%) patients, respectively. There were 48 (35.3%) pleomorphic adenomas, 36 (26.5%) schwannomas, and 24 (17.6%) paragangliomas. Conventional surgical techniques were performed in 83 patients, and robotic surgical approaches were administered to 53 patients. Transcervical-parotid and transcervical approaches were most commonly performed in conventional surgery, while transoral and retroauricular approaches were the preferred surgical methods in robotic surgery for pre- and poststyloid PPS tumors, respectively. Robotic surgery resulted in less estimated blood loss during poststyloid PPS tumor surgery. Postoperative cranial nerve complications were noted in 36 of 83 cases (43.4%) in the conventional surgery group and in 17 of 53 cases (32.1%) in the robotic surgery group. Intraoperative tumor spillage of pleomorphic adenoma showed no significant differences between the two groups (13.6% in conventional vs. 15.4% in robotic surgery). The mean follow-up time was 4.9 ± 3.4 years, and recurrences were observed in two patients during follow-up without a significant difference between the two groups (4.5% in conventional vs. 3.8% in robotic surgery). CONCLUSIONS Robotic surgery in PPS tumors is feasible through transoral, retroauricular, or combined approaches and provides treatment outcomes comparable to those of conventional open surgery.
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Affiliation(s)
- Jae-Yol Lim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Seok Kang
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
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19
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The Role of Transoral Robotic Surgery for Parapharyngeal Space: Experience of a Tertiary Center. J Craniofac Surg 2019; 31:117-120. [PMID: 31634316 DOI: 10.1097/scs.0000000000005912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The parapharyngeal space (PPS) is an anatomically and functionally complex region of the craniofacial district. Tumors that originate from this region are rare, and surgery is currently the best practice in the vast majority of cases with different surgical approaches being reported in the literature. Recently, mini-invasive robotic/endoscopic techniques have begun to emerge as effective alternatives in selected cases. In this work, we retrospectively analyzed 17 patients affected by PPS tumors, and managed by transoral robotic surgery (TORS) as a therapeutic or diagnostic procedure. TORS was used alone or combined with a transcervical approach for huge lesions of the PPS, at risk of fragmentation (curative intent). TORS also permitted biopsies of unknown lesions of the PPS to be conducted (diagnostic intent) otherwise unreachable without performing a mandibulotomy. All patients treated with curative intent benefited from radical surgery. No major complications were observed, and tumor fragmentation occurred only in 2 of 17 patients (11.8%). All patients receiving TORS with diagnostic intent were successfully referred to nonsurgical treatments based on the final histhopathological findings. This work also demonstrated TORS to be effective and safe on a larger group of patients compared to our preliminary study in 2016. TORS provides good oncological and functional outcomes when used with curative intent and is an effective diagnostic tool in cases of suspicious lesions of the PPS.
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20
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Jain PV, Sharan R, Manikantan K, Biswas G, Ray S, Arun P. Unusual loco-regional presentation in papillary carcinoma of thyroid: A case series. Indian J Cancer 2019; 56:325-329. [PMID: 31607701 DOI: 10.4103/ijc.ijc_368_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Papillary carcinoma of thyroid (PTC) is usually indolent with good prognosis and excellent long-term survival. However, PTC sometimes presents itself in unusual situations, posing diagnostic and therapeutic challenges. Owing to paucity of data, there is lack of consensus as to what treatment should be prescribed in patients with loco-regional spread other than the usual sites. MATERIALS AND METHODS Six patients of PTC presenting with involvement of the aero-digestive tract, retropharyngeal, and para-pharyngeal lymph nodes and great vessels of the neck are included in this case series. RESULTS AND CONCLUSION Though rare, unusual loco-regional presentation of PTC poses challenges in diagnosis and treatment. A keen clinical sense is paramount in effectively diagnosing these cases. Aggressive surgical resection and reconstruction results in good functional and aesthetic outcomes. Further studies are required for establishing specific guidelines on the approach to the treatment of these cases.
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Affiliation(s)
- Prateek V Jain
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Rajeev Sharan
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Kapila Manikantan
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Gautam Biswas
- Department of Plastic and Reconstructive Surgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Soumendranath Ray
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Pattatheyil Arun
- Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India
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21
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Abstract
Objective Primary parapharyngeal space (PPS) tumors are one of the most challenging head and neck tumors to diagnose and treat. We analyzed our experience in patients with PPS tumors who were treated in our hospital over 13 years. Methods We retrospectively reviewed 16 patients with PPS tumors between 2006 and 2018. The study included clinical symptoms, histological types, surgical approaches, adjuvant therapies, postoperative complications, and prognosis. Results The mean age of the patients was 49.63 ± 17.03 years. A palpable neck mass (56.3%) was the most common symptom. In our series, 78.6% of the tumors were benign, and of these, schwannomas were the most common (6/14, 42.9%). Three surgical approaches were used in our patients, including transmandibular (57.1%), transcervical (21.4%) and transparotid (21.4%) approaches. Few complications were reported, including hoarseness and numbness. Adjuvant therapy was administered depending on pathological parameters of the tumors. No recurrence was observed during a mean follow-up of 60.6 months in patients with malignant tumors. Conclusions Radiological studies of PPS tumors are essential for diagnosis and surgical planning. Excision of PPS tumors using appropriate surgical approaches provides good outcomes.
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Affiliation(s)
- Kuang-Hsu Lien
- 1 Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,2 School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Kuang Young
- 2 School of Medicine, Chang Gung University, Taoyuan, Taiwan.,3 Department of Otolaryngology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shy-Chyi Chin
- 2 School of Medicine, Chang Gung University, Taoyuan, Taiwan.,4 Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Chun-Ta Liao
- 1 Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shiang-Fu Huang
- 1 Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,5 Department of Public Health, Chang Gung University, Taoyuan, Taiwan
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22
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Surgical Treatment of Primary Parapharyngeal Space Tumors: A Single-Institution Review of 28 Cases. J Oral Maxillofac Surg 2019; 77:1520.e1-1520.e16. [DOI: 10.1016/j.joms.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 11/19/2022]
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23
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Dang S, Shinn JR, Seim N, Netterville JL, Mannion K. Diagnosis and treatment considerations of parapharyngeal space masses – A review with case report. OTOLARYNGOLOGY CASE REPORTS 2019. [DOI: 10.1016/j.xocr.2019.100120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Panda S, Sikka K, Thakar A, Sharma SC, Krishnamurthy P. Transoral robotic surgery for the parapharyngeal space: expanding the transoral corridor. J Robot Surg 2019; 14:61-67. [DOI: 10.1007/s11701-019-00932-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/08/2019] [Indexed: 11/30/2022]
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25
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A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space. J Robot Surg 2019; 14:233-236. [DOI: 10.1007/s11701-019-00930-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/21/2019] [Indexed: 12/23/2022]
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26
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Ferrari M, Schreiber A, Mattavelli D, Lombardi D, Rampinelli V, Doglietto F, Rodella LF, Nicolai P. Surgical anatomy of the parapharyngeal space: Multiperspective, quantification-based study. Head Neck 2018; 41:642-656. [DOI: 10.1002/hed.25378] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Marco Ferrari
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Francesco Doglietto
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
| | - Luigi Fabrizio Rodella
- Section of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences; University of Brescia; Brescia Italy
| | - Piero Nicolai
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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27
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López F, Suárez C, Vander Poorten V, Mäkitie A, Nixon IJ, Strojan P, Hanna EY, Rodrigo JP, de Bree R, Quer M, Takes RP, Bradford CR, Shaha AR, Sanabria A, Rinaldo A, Ferlito A. Contemporary management of primary parapharyngeal space tumors. Head Neck 2018; 41:522-535. [PMID: 30549361 DOI: 10.1002/hed.25439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Iain J Nixon
- NHS Lothian, University of Edinburgh, Edinburgh, United Kingdom
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clínica Vida/Instituto de Cancerología Las Américas, Medellín, Colombia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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28
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Chen Z, Chen YL, Yu Q, Zhou SH, Bao YY, Shang DS, Ruan LX. Excision of tumors in the parapharyngeal space using an endoscopically assisted transoral approach: a case series and literature review. J Int Med Res 2018; 47:1103-1113. [PMID: 30526171 PMCID: PMC6421391 DOI: 10.1177/0300060518816190] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) provides important information regarding tumors in the parapharyngeal space (PPS), revealing their origin, whether they are benign or malignant, and their relationships with surrounding structures. METHODS Twelve tumors in the PPS were completely excised using an endoscopically assisted transoral approach (EATA). The MRI features were analyzed. RESULTS Ten pleomorphic adenomas confirmed on postoperative pathological examination had the parotid pedicle sign. A fat space between the tumor and parotid gland may distinguish such a tumor from a tumor arising from a minor salivary gland in the prestyloid space and a tumor arising from the deep lobe of the parotid gland. Both the jugular vein and carotid artery were displaced posteriorly in all 10 cases of pleomorphic adenomas. The principal features of the two schwannomas confirmed on postoperative pathological examination were separation of the internal carotid artery and internal jugular vein and anteromedial displacement of the internal carotid artery, suggesting that the tumors originated in the poststyloid space. In this review, 95 tumors were excised by the EATA in the English-language literature. CONCLUSIONS MRI renders differential diagnosis possible. PPS tumors may be completely excised via an EATA guided by tumor features evident on preoperative MRI.
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Affiliation(s)
- Zhe Chen
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Ya-Lian Chen
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Qi Yu
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Shui-Hong Zhou
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - Yang-Yang Bao
- 1 Department of Otolaryngology, Hangzhou City, Zhejiang Province, China
| | - De-Sheng Shang
- 2 Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ling-Xiang Ruan
- 2 Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Diagnosis and management of pediatric cervical vagal schwannoma. Int J Pediatr Otorhinolaryngol 2018; 114:9-14. [PMID: 30262374 DOI: 10.1016/j.ijporl.2018.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
Schwannomas arising from the vagus nerve are extremely rare in children, with only 15 cases reported in the world literature. We describe a pediatric case of cervical vagal nerve schwannoma successfully treated with cranial nerve-sparing surgery. Our patient presented extensive mass in the right side of the neck with ipsilateral Horner's syndrome. Her first sign, anisocoria, was diagnosed at the age of 1.5 y, making her the youngest vagal schwannoma case ever reported. Using an ultrasonic surgical aspirator and nerve monitoring, a multidisciplinary team successfully removed the mass with no recurrence after 2 years of follow-up.
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Chabrillac E, Morinière S, Jegoux F, Blanchard D, Choussy O, Hans S, Vergez S. Transoral robotic resection of benign tumors of the upper aerodigestive tract: Experience of the French group of GETTEC. Head Neck 2018; 40:2043-2049. [PMID: 29697873 DOI: 10.1002/hed.25197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/13/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the current use of transoral robotic surgery (TORS) in benign tumors of the upper aerodigestive tract through a case series and a literature review. METHODS This multicentric retrospective study was conducted in 6 French centers between November 2009 and July 2017. RESULTS Twenty-one patients had a TORS resection of a tumor at varied locations with differing histopathologic characteristics. The mean postoperative hospital stay was 6.1 days. Eight patients had nasogastric tubes, which were removed after a mean of 5.6 days. Two patients had a prophylactic tracheostomy for an average of 5.5 days. A third tracheostomy was performed secondarily for postoperative bleeding. No recurrences were observed during the 2-year follow-up. CONCLUSION This technique caused few complications and resulted in short hospitalization, with satisfactory functional and recurrence outcomes. However, the risk of bleeding and edema must be considered, and the need for a tracheostomy must be approached wisely.
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Affiliation(s)
- Emilien Chabrillac
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
- Department of Surgery, University Cancer Institute Toulouse, Toulouse, France
| | - Sylvain Morinière
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Tours University Hospital, Cedex, France
| | - Franck Jegoux
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | - David Blanchard
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Institut Curie Hospital, Paris, France
| | - Olivier Choussy
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Stéphane Hans
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
- Department of Surgery, University Cancer Institute Toulouse, Toulouse, France
| | - Sébastien Vergez
- Department of Ear, Nose, and Throat - Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France
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He H, Yang Q, Gong J, Luo L, Huang T, Chen Z, Guo Y, Li W. Endoscopic Transvestibular Transmandibular Approach for Trigeminal Schwannoma in Infratemporal Fossa and Parapharyngeal Space. World Neurosurg 2018; 118:172-176. [PMID: 30031184 DOI: 10.1016/j.wneu.2018.07.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Schwannomas that involve the mandibular division of the trigeminal nerve and localize exclusively in the parapharyngeal space (PPS) and infratemporal fossa (ITF) are extremely rare, and a surgical approach to treat such tumors has not been well established. CASE DESCRIPTION We present our experience in the treatment of a giant trigeminal schwannoma with wide extension in the ITF and PPS using an endoscopic transvestibular transmandibular approach. The clinical and radiologic findings, preoperative planning, advantages of the surgical approach, and clinical outcome are discussed. CONCLUSIONS Schwannomas located in the ITF and PPS are rare benign neoplasms. They are usually detected late after considerable signs and symptoms appear. Preoperative planning is beneficial to individual surgical approach selection. Total surgical excision following careful evaluation of preoperative computed tomography and magnetic resonance images is the treatment of choice. Recurrence is rare after complete excision.
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Affiliation(s)
- Haiyong He
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qintai Yang
- Department of Otolaryngology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin Gong
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lun Luo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tengchao Huang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhuopeng Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Guo
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wensheng Li
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Gorphe P, Auperin A, Honart JF, Ton Van J, El Bedoui S, Bidault F, Temam S, Kolb F, Qassemyar Q. Revisiting vascular contraindications for transoral robotic surgery for oropharyngeal cancer. Laryngoscope Investig Otolaryngol 2018; 3:121-126. [PMID: 29721545 PMCID: PMC5915826 DOI: 10.1002/lio2.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/05/2018] [Accepted: 03/01/2018] [Indexed: 12/25/2022] Open
Abstract
Objective We analyzed the outcomes for patients with a retropharyngeal internal carotid artery (ICA) who underwent a transoral robotic surgery (TORS) procedure involving a cervical‐transoral robotic oropharyngectomy course with free flap reconstruction. Methods Patients were included in the prospective multicentric trial NCT02517125. These patients were scheduled to undergo surgery for an oropharyngeal localization. By pre‐operative CT scan and MRI it was determined that they had a retropharyngeal internal carotid artery. Results Three patients had a retropharyngeal ICA: a patient with a 35 mm synovial sarcoma of the tonsillar fossa, a patient with a T2N2b squamous‐cell carcinoma (SCC) of the glossotonsillar sulcus, and a patient with a T3N0 SCC of the tonsillar fossa in a previously irradiated field. These patients encountered neither preoperative nor postoperative complications. Conclusions In our experience, TORS for oropharyngeal cancers appears to be feasible in patients with a retropharyngeal ICA, provided that the procedure has been adapted for complex situations. Level of evidence 4.
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Affiliation(s)
- Philippe Gorphe
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Anne Auperin
- Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean-François Honart
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Jean Ton Van
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Sophie El Bedoui
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Statistics Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France.,Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - François Bidault
- Department of Radiology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Stéphane Temam
- Department of Head and Neck Oncology Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Frédéric Kolb
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
| | - Quentin Qassemyar
- Department of Plastic and Reconstructive Surgery Gustave Roussy, Université Paris-Saclay, Villejuif, France; and the Department of Head and Neck Oncology, Oscar Lambret Lille France
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