1
|
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.
Collapse
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
| |
Collapse
|
4
|
Iglesias-Moreno MC, López-Salcedo MA, Gómez-Serrano M, Gimeno-Hernández J, Poch-Broto J. Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center. Acta Otolaryngol 2015; 136:298-303. [PMID: 26588771 DOI: 10.3109/00016489.2015.1104724] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Pre-operative planning for parapharyngeal tumors must include meticulous analysis. Factors such as tumor size, distance to cranial base, and relation to neurovascular structures must guide the selection of a surgical approach. OBJECTIVE To summarize experience in diagnosis and surgical management of parapharyngeal tumors, analyzing the frequencies of various tumoral types, clinical presentation, choice of surgical approach and outcomes. This study also compares the results with the most relevant case series in the literature. METHODS A retrospective review was performed of the records of 51 patients treated by the team, from 1984-2012. Only primary tumors were included, excluding invasion from adjacent spaces and metastatic disease. All patients underwent imaging studies and surgical resection of the neoplasm. Cytological analysis and arteriography were used on an individualized basis. Surgical excision was performed via different approaches, predominantly through a cervicoparotid route. RESULTS Benign neoplasms were predominant (80%), and the most frequent tumor was pleomorphic adenoma. FNAC had a 100% accuracy to differentiate benign vs malignant tumors. The most common post-operative sequel was compromise of a cranial nerve, and three patients presented local complications after surgery. After follow-up, only three of 41 patients with benign tumors had recurring disease.
Collapse
Affiliation(s)
- M C Iglesias-Moreno
- a Department of Otolaryngology - Head and Neck Surgery , Hospital Clínico San Carlos , Madrid , Spain
| | - M A López-Salcedo
- a Department of Otolaryngology - Head and Neck Surgery , Hospital Clínico San Carlos , Madrid , Spain
| | - M Gómez-Serrano
- a Department of Otolaryngology - Head and Neck Surgery , Hospital Clínico San Carlos , Madrid , Spain
| | - J Gimeno-Hernández
- a Department of Otolaryngology - Head and Neck Surgery , Hospital Clínico San Carlos , Madrid , Spain
| | - J Poch-Broto
- a Department of Otolaryngology - Head and Neck Surgery , Hospital Clínico San Carlos , Madrid , Spain
| |
Collapse
|
5
|
Chan JYK, Tsang RK, Eisele DW, Richmon JD. Transoral robotic surgery of the parapharyngeal space: A case series and systematic review. Head Neck 2014; 37:293-8. [DOI: 10.1002/hed.23557] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jason Y. K. Chan
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Raymond K. Tsang
- Division of Otolaryngology - Head and Neck Surgery; Department of Surgery; University of Hong Kong, Queen Mary Hospital; Hong Kong SAR China
| | - David W. Eisele
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Jeremy D. Richmon
- Department of Otolaryngology - Head and Neck Surgery; Johns Hopkins Medical Institutions; Baltimore Maryland
| |
Collapse
|
6
|
Abstract
Parapharyngeal space tumors are rare, accounting for 0.5% of head and neck neoplasms. Most of them are benign and originate in the salivary glands, especially the pleomorphic adenoma. We presented a 47-year-old man with parotid tail pleomorphic adenoma extending to the parapharyngeal space. The patient applied to our clinic with the complaints of a painless mass on his neck and in his mouth for 3 months. After fine needle aspiration biopsy, the mass was diagnosed as pleomorphic adenoma. The patient was hospitalized and operated in our clinic. As we see in literature review, parapharyngeal space tumors are rare, and most of them are pleomorphic adenomas arising from the deep lobe of the parotid gland and extend into the PPS.
Collapse
|