Abstract
Background Surgical removal of parapharyngeal space tumors (PPST) poses challenges due to the
complex anatomy of the region. PPSTs are routinely resected by a transcervical approach
using blind finger dissection. Large PPSTs or those located high at the skull base,
often require transmandibular or infratemporal fossa approaches, associated with considerable
morbidity.
Objective Here, we describe an approach for PPST removal that comprises transcervical endoscopic,
with or without transoral robotic technique.
Materials and Methods We retrospectively studied the demographic, clinical, surgical, and outcome data
of 11 consecutive patients who underwent PPST excision between June 2013 and July
2017 at our center. Patients either underwent a transcervical endoscopic procedure
(n = 4), a transoral robotic procedure (n = 2) or a combination of the two procedures (n = 5).
Results Complete tumor excision was achieved in all cases, with no intra-, peri-, or postoperative
complications. Final histopathologic findings demonstrated pleomorphic adenoma for
seven patients, cavernous hemangioma for one patient, and malignant tumors for three
patients. The average tumor size was 44.22 ± 31.9 cm3 (range: 7.5–111 cm3). At follow-up (range: 3–42 months), there was no evidence of recurrence.
Conclusions The approach described provides improved visualization and safe vascular control
with minimum tumor stress, preventing the need for blind finger dissection, and allowing
complete tumor removal while minimizing tumor spillage, nerve injury, and blood loss,
maintaining excellent cosmetic and functional results. This approach could be utilized
for the removal of large benign PPST, or small PPST located high.
Keywords
parapharyngeal space - parapharyngeal space tumor - minimally invasive - transoral
robotic surgery - da Vinci robot system
