Management of Parapharyngeal Space Tumors: Clinical Experience with a Large Sample and Review of the Literature

Parapharyngeal space (PPS) tumors are rare, and they account for 0.5-1.5% of all head and neck tumors. This study summarized the findings of large-sample clinical studies of PPS tumors and reported the clinical work-up and management of 177 cases of PPS tumors at our center. This retrospective study included patients treated for PPS tumors between 2005 and 2020 at our center. The basic characteristics, symptoms, surgical approach, complications, and recurrence rates were analyzed. A total of 99 male and 78 female patients, with a mean age of 48.3 ± 15.1 years, were enrolled in this study. The most common symptoms were external or intraoral masses (114 patients, 64%). Surgical management leveraging, a cervical approach, was used for 131 cases (74%). The tumors were benign for 92% (160 cases), with pleomorphic adenoma being the most common (88 cases, 50%). Surgical complications were reported for 31 cases (18%); facial and vocal cord paralyses were the most common. Three cases of recurrence were observed during the follow-up. PPS tumors are rare and present with atypical clinical manifestations. The current study, which involved cases in a large single center, demonstrates the importance of surgical interventions for PPS tumors. The use of endoscopic techniques has further expanded the scope of traditional surgical approaches and demonstrated its advantages in selected cases.

Garcin syndrome in a case of acquired immunodeficiency syndrome

In this study, we report a parapharyngeal diffuse large B-cell lymphoma in a human immunodeficiency virus (HIV) infected patient which had caused the patient to suffer from Garcin syndrome.

[Indications for resection of parapharyngeal space tumors by transoral robotic surgery and prevention and treatment of complications]

Objective:This study investigated the clinical indications, prevention and management of common complications of TORS resection of parapharyngeal space tumors. Methods:The clinical data of 23 patients with parapharyngeal space tumors treated with TORS in the Eye & ENT Hospital of Fudan University from July 2020 to February 2022 were retrospectively analyzed. The surgical methods were divided into simple TORS surgery and TORS combined endoscopic or cervical surgery. The surgical incision can be directly sutured or partially sutured. If the surgical cavity is below the oropharyngeal plane and there is a risk of airway compression, preventive tracheotomy would be performed. No drainage（15 cases） or transnasal negative pressure drainage tube（8 cases） was placed in the operation cavity. In 17 cases, tumors were located between the top of nasopharynx and the lower boundary of oropharynx and these patients underwent simple TORS surgery; one case received combined cervical and endoscopic surgery, as the tumor was located near the skull base with unclear boundary with the deep lobe of parotid gland; five cases underwent combined endoscopic surgery, as the tumor reached the upper part of the nasopharynx or the outer part of the parapharyngeal space. Results:One case underwent emergency hemostasis for postoperative bleeding, and three cases underwent puncture and drainage for postoperative effusion. No complication occurred such as postoperative infection and airway obstruction. The healing grade of surgical incision and surgical cavity in transnasal drainage group was significantly better than that in non-drainage group. Conclusion:TORS operation is a safe and minimally invasive method in treating parapharyngeal space tumors with appropriate size and location. Postoperative effusion is a common complication after TORS. In case that surgical cavity extends to the deep parapharyngeal space or the lower part of the surgical cavity is beneath the surgical incision, the placement of transnasal negative pressure drainage tube after operation can improve postoperative recovery and reduce the incidence of complications such as effusion and infection.

The intraoral growth patterns of parapharyngeal tumors: A proposed classification system

OBJECTIVE

Nearly half of parapharyngeal space (PPS) tumors present as an intraoral mass, which is diagnostically challenging. In this study, we studied whether preoperative growth patterns were associated with histopathological diagnosis for planning surgery.

METHODS

We performed a cross-sectional study in patients with PPS tumors. A simplified classification scheme based on intraoral tumor growth patterns (patterns 1 and 2) was then proposed. In pattern 1, tumors bulge submucosally to the oropharynx from the soft palate, with the center convexity above the uvula. In pattern 2, tumors bulge submucosally to the oropharynx from the lateral oropharynx wall, with the center convexity below the uvula. The association of this classification with postoperative histopathological diagnosis and surgical-related events was studied.

RESULTS

Twenty-two patients were enrolled in this study (12 with pattern 1, 10 with pattern 2). Of these, 91.7% (11/12) of pattern 1 tumors were salivary gland tumors (P < .001), and 90% (9/10) of pattern 2 tumors were neurogenic (P < .001). Pattern 2 tumors had fewer bleeding complications or needed external approaches when a transoral approach was chosen.

CONCLUSIONS

This new classification of PPS tumors facilitates the prediction of salivary gland and neurogenic tumors and can improve the accuracy of preoperative radiologic diagnosis. This system will be helpful for planning surgical interventions, such as implementing transoral approaches.

[Endoscope-assisted transoral resection of parapharyngeal space tumors: a retrospective study]

Objective:To evaluate the feasibility and safety of the endoscope-assisted transoral approach for the parapharyngeal space（PPS） tumors. Method:This retrospective study included 22 patients who were diagnosed with PPS tumors and treated with the endoscope-assisted transoral approach. Result:The postoperative pathological diagnosis included 10 cases of schwannoma, 7 cases of pleomorphic adenoma, 1 case of paraganglioma, 1 case of branchial cleft cyst, and 3 cases of malignant tumors for a diagnostic purpose. The surgical duration was between 15 minutes and 430 minutes（median duration 105 minutes）, and the intraoperative bleeding was between 10ml to 500ml（median bleeding 20 mL）. Complete resection with minor complication was performed in 21 cases, 1 case of recurrent schwannoma was done in an incomplete style because of intraoperative massive bleeding. With a 12-to-72-months follow up, there was no relapse on the 18 cases of benign tumor which were completely resected. Conclusion:Endoscope-assisted transoral resection provide cosmetic, micro-invasive and increased operative exposure to the PPS, especially for the benign tumors that medial to the carotid sheath. But is not recommend for relapsed cases and lesions that encompassing or lying posterolateral to the carotid sheath.

[Retrospective analysis of primary parapharyngeal space tumors]

Objective:To explore the clinical feature and surgical treatment of patients with parapharyngeal space tumors. Method:A retrospective review of 214 cases with parapharygeal space tumors treated. The data on clinical manifestations, imaging examinations, pathological types, surgical approach, and postoperative complications were reviewed. Result:Of the 214 cases, the tumor was benign in nature in 135 cases（63.1%） and malignant in 79 cases（36.9%）. There was no gender difference in the incidence of benign tumors, and the ratio of male to female was 1:1. The incidence of malignant tumors was higher in males than in females, and the ratio was 3.3:1. Regardless of benign and malignant tumors, the high incidence age is 40-59. Two-thirds of cases of parapharyngeal space tumors had different degrees of peripheral structural invasion. The most common cases involving the skull base were 76 cases（35.5%）, followed by blood vessels and nerves, 24 cases（11.2%） and 16 cases（7.5%）,respectively. Complications occurred in 65 patients（31.4%）, the most common complications were hoarseness caused by X-cranial nerve palsy. Conclusion:There are various pathological types of parapharyngeal space tumors, and surgery is the first choice for parapharyngeal space tumors. The surgical plan should be made according to the imaging examinations, lesions, and the pathology et al. The risk of complications should be fully informed before the operation, and the cooperation of the patients should be obtained.

[The surgical management of upper parapharyngeal regions]

Objective: To find proper the surgical approval and evaluate clinical efficacy to treat the tumor of upper parapharyngeal space involving the base of skull and intracranial skull. Method: The data of 9 cases from June 2013 and June 2018 were analyzed retrospectively including schwannoma in 6 cases, pleomorphic adenoma in 2 cases and hemangioma in 1 case. All cases received preoperative high resolution CT and MRI, some cases also did the DSA examination. Tumor invaded top of nasopharyngeal in 4 cases, the base of skull in 3 cases, and intraskull in 2 cases. 9 cases were treated with surgery alone. Surgical approach: transcervical approach (n=1), transcervical approach and mandibular fracture surgery(n=2), transoral approach(n=3), transnasal transpterygoid approach(n=2), transparotid gland approach(n=1). Result: Tumors in 8 cases were completely removed, and 1 case was performed by partial excision. Hemorrhage(>500 ml) occurred in 2 cases, tongue deflection and cerebrospinal fluid leakage occurred in 1 case. No death, tumor recurrence and wound infection was found. Conclusion: The position of benign upper parapharyngeal space tumors is deep and tumor often invade in the base of the skull and brain tissue. It is close to the important nerve, vessels of the skull base and meninges. The appropriate surgical approach should be selected according to the individual situation. The main point of the operation is complete the tumor resection with preserving or reconstructing the important function of the blood vessel and nerve.

[Analysis and surgical treatment of 72 cases of parapharyngeal space tumors]

Objective:To summarize and analyze the clinical features, diagnosis methods, surgical approaches and treatment outcomes of patients with parapharygeal space tumors.Method:A retrospective review of 72 cases with parapharygeal space tumors treated from March 1994 to June 2017 was performed. The data on presentation, surgical approach, histological diagnosis and postoperative complications were reviewed.Result:The postoperative pathological diagnosis included 62 benign tumors and 10 malignant tumors. The most frequent symptom was a cervical mass or an intraoral swelling. All patients underwent preoperative enhanced CT scan or MRI,which would be helpful to evaluate the tumor sizes,locations and possible sources,and to make operation scheme. The postoperative pathology included 24 salivary gland lesions and 30 neurogenic lesions. The postoperative complications happened in 13 patients. The surgical approaches included trans-cervical approach in 55 cases, cervical-parotid approach in 9 cases,trans-oral approach in 6 cases , and trans skull base approach in 2 case.Conclusion:A parapharygeal space tumor is an uncommon tumor and requires careful preoperative assessment. Surgery is the first choice for parapharygeal space tumors. These patients should be counseled appropriately about the potential for permanent cranial nerve deficits.

[Endoscopic transoral resection the tumors of the higher position in parapharyngeal space: a retrospective case-control study]

Objective:To analysis the indication and security of the endoscopic resection of transoarl and pterygoid process approach of neoplasms in elevatus parapharyngeal space.Method:A retrospective case-control study were carried out in 22 patients with parapharyngeal space tumors.In the observation group (11 patients), tumors were endoscopic resected by transoral and pterygoid process approach. Paired with 11 patients (control group) who underwent surgry by traditional approach. We compared the en bloc resection rate, the operation time, blood loss, postoperative hospital stay, complication rate between the two groups.Result:In the observation group, the operation time, the blood loss and the postoperative hospital stay was (122.45±22.2)min, (97.26±13.75)ml, (4.09±1.22)d respectively. While in the control group, the operation time, the blood loss and the hospitalized days was (134.36±20.38)min, (213.64±63.99)ml, (5.10±0.99)d respectively. There were tumors that were block resection in both groups. In the observation group, there were a recurrence. Comparing the operation time, en bloc resection rate and postoperative hospital stay, there were no significant differences. There were differences in bloods loss between the two groups.Conclusion:The endoscopic transoral resection the tumors of the higher position in parapharyngeal space is safe, minimally invasive and feasible in selected cases, with a high local control rate and a low surgical complication rate.

Diagnostic dilemma involving a mass in the parapharyngeal space: A metastatic breast carcinoma masquerading as a malignant salivary gland tumor

Parapharyngeal space (PPS) tumors are rare and account for about 0.5% of all head and neck neoplasms. Most PPS tumors are benign (up to 80%) while the remaining 20% are malignant. These tumors are either primaries; most commonly arising from salivary glands or metastatic tumors or due to direct extension of tumors from the adjacent sites. Distant metastasis from breast cancers more commonly involves the lungs, bones, brain and liver. Metastasis to the PPS from a primary breast carcinoma is rare, with only one case reported in literature. We, to the best of our knowledge report the second case of a carcinoma breast metastasizing to the PPS and further discuss the diagnostic and therapeutic challenges involved in its management. A fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan apart from explicitly defining the extent of the PPS tumor, majorly influenced the therapeutic decision making process by ruling out other sites of metastasis.

Clinicopathologic study of parapharyngeal tumors

BACKGROUND

Parapharyngeal space (PPS) tumors are rare. Three main groups are identified, namely those of salivary origin, neurogenic tumors and paragangliomas. Early pathological classification of PPS tumors is important for pin point diagnosis and timely management.

AIMS

The PPS is a complex anatomical potential space and poses high risk of per and postoperative complication. This study was done to perform optimum preoperative evaluation by clinicoradiologic correlation and guided fine needle aspiration cytology (FNAC) which is essential to minimize intraoperative risk.

MATERIALS AND METHODS

Guided FNAC was carried out to diagnose parapharyngeal tumors in 48 patients from January 2008 to January 2010. The inflammatory lesions were excluded in the present study. Correlation with histopathology was done in all the cases.

RESULTS

The mean age for all the patients was 38.2 years. There were 23 male and 25 female subjects. Seventy nine percent of the lesions were benign with pleomorphic salivary adenoma being the commonest, while only 20.8% of the lesions were malignant. All the patients presented with neck swelling. No complication was encountered in the present study.

CONCLUSION

FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report.