Transoral Excision of Parapharyngeal Tumors

Transoral Approach to Parapharyngeal Space Tumours: Preliminary Reports from a Single-Centre Retrospective Analysis

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.

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

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.

Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Literature

Parapharyngeal space and infratemporal fossa are 2 overlapping spaces in head and neck which have complex anatomy with vital neurovascular structures passing through them. Tumors of this region are extremely rare but majority of them (80%) are benign. Benign tumors of this region can lead to swellings in facial region, neck and oropharynx. Dysphagia may be a complaint of the patient. Many of these tumors have malignant potential. Removal of these tumors requires a good understanding of the anatomy of this space so that correct surgical approach can be selected. The surgeon needs to be adept in using the most suitable surgical approach for excision of these tumors. There are various approaches which can be used to access these deeply seated tumors but the issue of prime importance is selecting the appropriate approach for the various tumors here based on their size and their exact location in this complex anatomical space. Inappropriate approach can lead to inadequate tumor excision and can lead to injuries to the neurovascular structures in this region which can cause significant disability. The case series reported here describes the various approaches to this region and highlights the importance of correct selection of the surgical approach.

A Retrospective Analysis on the Effects and Complications of Endoscope-Assisted Transoral Approach and Lateral Cervical Approach in the Resection of Parapharyngeal Space Tumors

Objective

To observe and compare the effects and complications of endoscope-assisted transoral approach and lateral cervical approach in the resection of parapharyngeal space (PSS) tumors.

Methods

From January 2013 to September 2021, 69 patients with parapharyngeal space tumors in the Affiliated Hospital of Jiangnan University were divided into the control group (n = 37) and the observation group (n = 32) according to the mode of operation. The tumors in the parapharyngeal space were resected by the lateral cervical approach in the control group, and the tumors in the parapharyngeal space were removed by endoscopy-assisted transoral approach in the observation group. The general clinical data and operation conditions of the two groups, including operative blood loss, operation time, drainage volume and drainage time, hospital stay, perioperative pain degree, and tumor resection rate were collected and analyzed statistically. The patients were followed up for 6 months, and the complications of the two groups were recorded.

Results

Compared with the control group, the operation time in the observation group was significantly shorter, and the amount of intraoperative bleeding in the observation group was significantly less than that in the control group, and the difference was statistically significant (P < 0.05). The postoperative drainage was less and the hospital stay in the observation group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in tumor resection rate between the two groups. The visual analog scale (VAS) score on the 1st and 3rd day after operation in the observation group was lower than that in the control group. After treatment, some patients in the two groups had complications such as nerve injury, dysphagia, difficulty in mouth opening, massive hemorrhage, and parotid fistula. The total incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05).

Conclusions

The effect of the endoscope-assisted transoral approach is similar to that of the lateral cervical approach in the resection of tumors in parapharyngeal space, but the endoscope-assisted transoral approach has shorter operation time, less intraoperative bleeding, and less postoperative drainage. The indwelling time and hospital stay of the drainage device were shorter than those of the patients with transcervical approach, and the perioperative stress response of patients with endoscope-assisted transoral approach is mild, which is beneficial to the physical and mental recovery of the patients.

Use of Propensity Score Matching to Compare Short Outcomes from Transoral and External Surgical Approaches in Patients with Deep-Lobe Parotid Pleomorphic Adenomas

To compare the outcomes of patients who had deep-lobe parotid gland pleomorphic adenomas (PAs) that extended into the parapharyngeal space after surgical treatment, using a transoral approach or an external approach. One hundred and twelve eligible patients, with deep-lobe parotid gland PAs, were enrolled in this retrospective study. The surgical outcomes were compared for patients who received a transoral approach and an external approach, using 1:1 propensity score matching (PSM). The outcome measures were recurrence rate, facial nerve deficit, Frey’s syndrome, and hospitalization time. The median follow-up time was 4.8 years. After PSM, the transoral approach and external approach groups had no statistically significant difference in recurrence (10.3% vs. 3.4%; p = 0.201). The transoral approach group had no facial nerve deficit, but 5 of 29 patients (17.2%) in the external approach group had transient facial nerve paralysis (p = 0.052). The external approach group had a longer hospitalization time than the transoral approach group (5 vs. 4 days, p = 0.0017). The use of a transoral surgical approach to treat patients with deep-lobe parotid gland PAs led to low recurrence, shorter hospitalization times, and good functional and cosmetic outcomes.