Tumor fibroso solitario (TFS) parafaríngeo: reporte de caso y revisión de literatura

El espacio parafaríngeo es una región donde puede surgir un amplio espectro de tumores, que son poco frecuentes y comprenden solo el 0,5 al 1,5% de las neoplasias de cabeza y cuello. Generalmente, son hallazgos y suelen presentarse como masas asintomáticas. Incluye neoplasias primarias, extensión directa de regiones adyacentes y enfermedad metastásica. La literatura describe múltiples patologías e histologías que pueden surgir de esta zona, entre ellas, tenemos los tumores fibrosos solitarios, que son un espectro de neoplasias mesenquimatosas fibroblásticas de histogénesis incierta, que generalmente involucran la pleura. Son lesiones muy poco frecuentes y su localización parafaríngea es excepcional, siendo su primer reporte en la literatura en 1993. Se presenta el caso de un tumor fibroso solitario del espacio parafaríngeo evaluado en nuestro centro, con su enfrentamiento diagnóstico, resolución quirúrgica y seguimiento respectivo, con el objetivo de presentar esta patología poco frecuente a nuestros colegas y contribuir al conocimiento médico.

The parapharyngeal space is a region where a wide spectrum of tumors can arise, which are rare and comprise only 0.5% to 1.5% of head and neck neoplasms. They are generally findings and usually present as asymptomatic masses. Includes primary neoplasms, direct extension from adjacent regions, and metastatic disease. The literature describes multiple pathologies and histologies that can arise from this area, among them, we have solitary fibrous tumors, which are a spectrum of fibroblastic mesenchymal neoplasms of uncertain histogenesis, which are generally the pleura. It is a very rare lesion and its parapharyngeal location is exceptional, being its first report in the literature in 1993. We present the case of a solitary fibrous tumor of the parapharyngeal space evaluated in our center, with its diagnos- tic confrontation, surgical resolution and respective follow-up, with the aim of presenting this rare pathology to our colleagues and contributing to medical knowledge.

Neurological Complications in Benign Parapharyngeal Space Tumors - Systematic Review and Meta-Analysis

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.

Ultrasound fusion navigation-guided core needle biopsy for lesions involved the parapharyngeal space, infratemporal fossa, and skull base: a pilot study / 中华超声影像学杂志

Objective:To explore the value of ultrasound fusion navigation technology in the biopsy of parapharyngeal-infratemporal fossa-skull base (PIS) lesions.Methods:This study was conducted at the First Affiliated Hospital of Sun Yat-Sen University from March 2021 to March 2022 and included 8 patients [3 females and 5 males; age, (50±20) years; range, 16-76 years] with PIS lesions who needed to clarify the pathological diagnosis. The ultrasound fusion navigation with CT or MRI was used to guide lesion biopsy, and the technical feasibility, pathological diagnostic results and complications were evaluated.Results:The biopsy procedures were successful in all 8 patients, and the lesion size ranged from 2.2 to 6.5 cm. The exact pathological diagnosis was obtained in 7 patients, and the diagnostic rate was 87.5% (7/8). No major complication was observed after the biopsy. Mild complications occurred in 1 case, with a incidence of 12.5% (1/8).Conclusions:Ultrasound fusion navigation-guided biopsy is feasible, effective, and safe in the biopsy of deep head and neck lesions.

Unusual case of isolated post-styloid parapharyngeal space metastasis in a treated case of carcinoma supraglottis: A case report and review of literature

Squamous cell carcinoma of supraglottis is a common head and neck malignancy, comprising 30% of laryngeal carcinoma. Supraglottic carcinoma commonly metastasizes to the Levels II, III, and IV cervical nodes, and distant metastases are uncommon. Delayed local and regional recurrences are known, local recurrence being more common. We report a case of carcinoma supraglottis with the advanced locoregional disease at initial presentation and treated with neoadjuvant chemotherapy followed by chemoradiotherapy with a complete response on post-treatment positron emission tomography-computed tomography (PET-CT) scan. Surveillance PET-CT showed an isolated lesion in the left post-styloid parapharyngeal space, where neurogenic tumors are more common and isolated nodal metastasis is unusual. We did ultrasound-guided FNAC and cytology confirmed the presence of metastatic poorly differentiated carcinoma.

Does Octreoscan add value in the differential diagnosis of parapharyngeal space lesions?

Abstract Objective: We sought to evaluate the added value of complementary functional imaging in the differential diagnosis of parapharyngeal space lesions, as well as the benefit of performing a structured evaluation of diagnostic cross-sectional examinations. Materials and Methods This was a retrospective study of 16 patients with parapharyngeal space lesions who were referred to our facility following a cross-sectional imaging study listing head and neck paraganglioma as a possible diagnosis. Each patient underwent somatostatin receptor scintigraphy with111In-pentetreotide (Octreoscan) prior to surgical resection of the lesion. In addition, the initial computed tomography (CT) or magnetic resonance imaging (MRI) scans were reviewed by two radiologists specializing in head and neck imaging, working independently, according to predefined diagnostic criteria. Results: Increased somatostatin receptor expression was observed in 14 of the 16 lesions evaluated. Histopathology of the surgical specimens showed that 11 of those 14 lesions were paragangliomas. Upon review, none of the three lesions for which there was a false-positive scintigraphy result (one intravascular meningioma and two schwannomas) were found to meet enough of the conventional imaging criteria for a diagnosis of paraganglioma. Conclusion: Structured analysis of imaging data increases the accuracy of the diagnosis of indeterminate parapharyngeal space lesions. Because of its high sensitivity, functional evaluation by somatostatin receptor scintigraphy should be considered a useful complementary tool for the detection of head and neck paraganglioma, provided that its limited specificity is taken into account.

Tumor maligno de la vaina nerviosa periférica del nervio vago: Reporte de un caso

Resumen Los tumores malignos de la vaina nerviosa forman parte del 5% de los sarcomas de partes blandas. Si bien son infrecuentes, su incidencia aumenta en caso de neurofibromatosis tipo 1. Cuando estos tumores están ubicados en cabeza y cuello, suelen ser asintomáticos, por lo que su diagnóstico es tardío. El tratamiento es principalmente quirúrgico, con una tasa de recidiva importante y pobre sobrevida a los 5 años. Se presenta el reporte de un caso de una paciente de 52 años con antecedentes de neurofibromatosis tipo 1 y un tumor maligno de vaina nerviosa periférica del nervio vago, localizado en el espacio parafaríngeo.

Abstract Malignant peripheral nerve sheath tumors are part of 5% of soft tissue sarcomas. Although they are infrequent, their incidence increases in case of neurofibromatosis type 1. When these tumors are located in the head and neck, they are usually asymptomatic, so their diagnosis is delayed. Treatment is primarily surgical, with a significant recurrence rate and poor 5-year survival. We present a case report of a 52-year-old patient with a history of type 1 neurofibromatosis and a malignant peripheral nerve sheath tumor of the vagus, located in the parapharyngeal space.

Adenoma pleomórfico del espacio parafaríngeo: una entidad escondida / Pleomorphic adenoma of the parapharyngeal space: a hidden entity

Resumen Los tumores del espacio parafaríngeo son poco frecuentes. Dentro de ellos, las neoplasias benignas son las más frecuentes, destacando principalmente los adenomas pleomorfos. Estos tumores suelen permanecer asintomáticos hasta alcanzar el tamaño suficiente para producir alteraciones debido al efecto de masa. A pesar de su naturaleza benigna, es necesario realizar resección completa dada su alta tasa de recurrencia y potencial de transformación maligna. Presentamos el caso de un paciente de 52 años que en estudio de vértigo se detecta incidentalmente una masa tumoral del espacio parafaríngeo de 45 mm × 32 mm de diámetro, de etiología incierta. Se realizó una biopsia incisional endoscópica que evidenció un adenoma pleomórfico, que actualmente se encuentra en etapa de evaluación y planificación de escisión completa. En conclusión, dado que los hallazgos clínicos y radiológicos no siempre son suficientes para determinar la naturaleza de las lesiones del espacio parafaríngeo, es importante contar con un diagnóstico histológico. Los avances en las técnicas de cirugía endoscópica sinusal han permitido acceder a esta zona con una mínima morbilidad y estadía hospitalaria. Debido a la posibilidad de transformación maligna los adenomas pleomórficos requieren un manejo activo.

Abstract Tumors of the parapharyngeal space are rare. Benign neoplasms are the most frequent and, among them, pleomorphic adenomas stand out. These tumors are usually asymptomatic until they reach a size large enough to produce symptoms due to mass effect. Despite its benign nature, it is necessary to perform a complete resection given its high recurrence rate and its potential for malignant transformation. We present the case of a 52-year-old man in whom a study of vertigo incidentally detected a mass in the parapharyngeal space measuring 45 mm × 32 mm in diameter, of unknown etiology. An endoscopic incisional biopsy was performed, showing a pleomorphic adenoma, which is currently under assessment to plan complete removal. In conclusion, as clinical and radiological findings are not always sufficient to determine the nature of parapharyngeal space lesions, it is important to obtain a histological diagnosis. Advances in endoscopic sinus surgery techniques have allowed access to this area with minimal morbidity and hospital stay. Due to the possibility of malignant transformation pleomorphic adenomas require active management.

Malignant peripheral nerve sheath tumor of the parapharyngeal space arising from cervical sympathetic chain: A rare entity

Malignant peripheral nerve sheath tumors (MPNSTs) of parapharyngeal space are rare and if present are most often in association with neurofibromatosis type 1 (NF-1). Only a few cases of MPNST have been reported in the literature without coexisting NF. We report one such case of an MPNST of parapharyngeal space tumor in a 35-year-old female with no associated features of NF-1. She presented with right-sided neck swelling and ptosis. Magnetic resonance imaging showed a 7 cm × 8 cm × 11 cm irregular swelling in the right parapharyngeal space with invasion of surrounding muscles. The mass was excised using a transcervical approach. Postoperative histopathological examination of the specimen revealed MPNST possibly arising from the cervical sympathetic chain

A Clinical Study On Primary Parapharyngeal Space Tumour

INTRODUCTION:Parapharyngeal space tumours are uncommon in head neck region. They are situated in a deep and complicated potential neck space. Mainstay of management remains surgical excision, though it is very difficult and complication prone. MATERIAS & METHODS:Aretrospective clinical study was done on 54 cases of primary PPS tumour. Their mode of presentation , imaging, cytopathology and histopathology results were noted. Different surgical approaches was evaluated.RESULTANALYSIS: Benign tumour was found in 81.5% cases. Salivary gland tumours were most common followed by schwannoma. CTscan is the first line investigation. Transcervical route is the most common surgical approach. CONCLUSION:Different types of tumours are found in PPS. Mortality and morbidity is related with surgery itself rather than the disease process. So surgeon must respect his learning curve.

Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors / 中华口腔医学杂志

Objective@#To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors.@*Methods@#A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study.@*Results@#Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death.@*Conclusions@#Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Clinical analysis of 27 cases with descending necrotizing mediastinitis / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the clinical manifestation and treatment strategy for descending necrotizing mediastinitis (DNM).@*Methods@#A total of 27 cases diagnosed as DNM from January 2010 to August 2018 in the First People’s Hospital of Foshan were reviewed. There were 16 males and 11 females, age ranged from 16 to 84 years. The clinical data were collected. SPSS 16.0 software and chi square test were used for statistical analysis.@*Results@#ALL 27 cases were diagnosed as DNM by contrast-enhanced CT scan of the neck and chest. Among the 27 cases, 13 cases resulted from peritonsillar abscess, 8 cases from esophageal foreign body perforation, 5 cases from parapharyngeal and retropharyngeal space abscess, and one case from infection of oral cavity. These 27 cases were divided into three subtypes according to the sites of mediastinitis, including 11 cases for typeⅠ, 5 cases for type ⅡA and 11 cases for type ⅡB. Of 27 cases, 20 cases underwent transcervical drainage for DNM, of which 5 cases with tracheotomy and 6 cases with thoracic drainage, and finally 19 of the 20 patients were cured, and one patient died of bacteremia; 7 cases refused to received surgery and were routinely treated with antibiotics, of which, one case was cured and 6 cases died. The curative rate in patients underwent surgery was significantly higher than that in patients treated with medication (χ2=13.638, P<0.001). Among the 20 cured cases, 4 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis, while in the 7 died cases, 5 cases were combined with diabetes mellitus and 6 cases with necrotizing fasciitis. The comorbidity rates of diabetes mellitus (χ2=4.074, P=0.044) and necrotizing fasciitis (χ2=4.457, P=0.035) in died cases were significantly higher than those in cured cases.@*Conclusion@#DNM is a serious infection, with high mortality especially in patients with diabetes and necrotizing fasciitis. Timely cervical and chest enhanced CT scan play vital role in its diagnosis. DNM can be treated effectively with transcervical drainage.

Plenitud ótica como primer síntoma en patología del espacio parafaríngeo / Otic fullness as a first symptom in parapharyngeal space pathology

RESUMEN Los tumores del espacio parafaríngeo (EP) son poco frecuentes, representando el 0,5%-1% de las neoplasias de cabeza y cuello. La distribución de los tumores del EP constituye: 40% tumores de glándulas salivales, seguidos de tumores neurogénicos y adenopatías. Presentamos un caso de una paciente de 52 años que acude por presentar sensación de taponamiento ótico izquierdo y molestias faríngeas de 3 meses de evolución. Tras una exploración otorrinolaringológica completa se sospecha patología del espacio parafaríngeo, que se confirma con las pruebas de imagen. Se realiza exéresis quirúrgica mediante abordaje transcervical-transparotídeo, con buena evolución posoperatoria y sin recidiva tras 1 año de seguimiento. El estudio anatomopatológico informa adenoma pleomorfo de parótida. En este trabajo se ha realizado una revisión de la etiopatogenia, diagnóstico y tratamiento de estas lesiones. Consideramos crucial realizar una exploración física otorrinolaringológica completa ante la presencia de un paciente con sintomatología inespecífica ya que el EP constituye un área anatómica difícil de explorar y que a menudo pasa desapercibida, por lo que la patología del EP representa un reto diagnóstico y terapéutico.

ABSTRACT Parapharyngeal space (PPS) tumors are infrequent and account for 0.5%-1% of head and neck neoplasms. Therefore, they represent a diagnostic challenge. The distribution of PPS tumors is as follows: 40% salivary tumors, followed by neurogenic tumors and adenopathies. We report a case of a 50 year old woman that presented with a 3-month history of otic fullness and pharyngeal disturbances. The otolaryngological examination showed PPS pathology that was confirmed by radiological images. Surgical excision by transcervical-transparotid approach was performed followed by uncomplicated healing with no recurrence in one year. The histological examination reported a pleomorphic parotid adenoma. The authors provide a discussion of the etiopathogenesis, diagnosis and treatment of this type of lesions. This clinical manuscript may shed light on the importance of a complete otolaryngological examination in a patient with unspecific symptoms considering that the PPS is a complex anatomic region and its pathology can easily go unnoticed.

Retrospective analysis of 188 cases of parapharyngeal space tumors / 临床耳鼻咽喉头颈外科杂志

To explore the diagnosis,treatment,surgical approach and prognosis of parapharyngeal space tumors.The clinical data of 188 patients with parapharyngeal space tumor who were treated from January 2007 to December 2016 were analyzed retrospectively.All patients underwent imaging examination before operation.Surgical approach was as follows:transcervical approach applied in 159 cases,endoscopic-assisted transnasal approach in 9 cases,transcervical-transmandibular approach in 8 cases,transcervical-transparotid approach in 8 cases,transoral approach in 7 cases,and infratemporal fossa approach in 4 case.Of the 188 cases,the tumor was benign in nature in 168 cases(89%)and malignant in 20 cases(11%).Complications occurred in 28(15%)patients,with the most common symptom being hoarseness.168 cases of benign tumors were followed up for 10 months to 10 years,and 3 cases were lost and 4 cases had recurrence.All cases underwent re-operation.Patients with malignant tumors received combined treatment after surgery,and 3 cases were lost to follow-up,1 case died of recurrence 9 months after surgery,the rest survived.Surgery is the preferred method for treating parapharyngeal space tumors and postoperative recurrence rate is pretty low.Endoscopy provides a new surgical management method,helping to reduce postoperative complications and recurrence rate.

Quiste de segundo arco branquial del espacio parafaríngeo en recién nacido: reporte de un caso / Second branchial cleft cyst parapharyngeal space in newborn: a case report

Dentro de los quistes cervicales congénitos los quistes branquiales son los segundos en frecuencia luego del quiste tirogloso, representando el 24% de los casos. De éstos, los quistes de segundo arco branquial son los más frecuentes con 90%-95% de los casos. Se presentan en un amplio rango de edad siendo comúnmente diagnosticados en niños mayores y adultos, cuya primera manifestación clínica puede ser un aumento de volumen relativamente brusco por infección. Se presenta el caso clínico de un recién nacido (RN) que debuta a las 48 horas de vida con estridor y dificultad para la alimentación oral. El estudio de imágenes con tomografía computarizada (TC) y resonancia magnética (RM) muestran una lesión quística del espacio parafaríngeo derecho que se proyecta hacia nasofaringe y orofaringe. Se realiza la exéresis de la lesión vía transoral. Biopsia rápida y diferida confirman diagnóstico de quiste branquial. Se revisa literatura sobre quistes de segundo arco branquial de ubicación en el espacio parafaríngeo siendo muy pocos los casos reportados.

Within the congenital cervical necks, the branchial cleft cyst are the second in the frequency after the shooting, accounting for 24% of the cases. Of the Second branchial cleft cyst are with the most frequent with 90-95% of the cases. It occurs in a wide range of ages and is commonly diagnosed in older children and adults, whose first clinical manifestation may be an increase in volume after infection. We present a clinical case of newborn that debuts at 48 hours of life with stridor and difficulty for oral feeding. The imaging study with Computed Tomography (CT) and Magnetic Resonance imaging (MRI) show a cystic lesion of the right parapharyngeal space projecting into the nasopharynx and oropharynx. The excision of the transoral lesion is performed. Frozen biopsy and diagnostic biopsy demonstrating a branchial cyst. We review the literature on the second branchial cleft cyst of the location in the parapharyngeal space with very few reported cases.

Resección transoral-transnasal de tumores del espacio parafaríngeo / Transoral-transnasal approach to parapharyngeal space tumors

Objetivos: Determinar la tasa de resección quirúrgica completa en tumores seleccionados del Espacio parafaríngeo tratados por vía transoral o transnasal o por ambas. Diseño: descriptivo, retrospectivo. Materiales y métodos: Se incluyeron en este estudio los pacientes que tuvieron neoplasias localizadas en el espacio parafaríngeo y que fueron tratados con cirugía por vía transoral o transnasal. El abordaje transoral consistió en realizar una incisión con cauterio en la zona de mayor protrusión del tumor (pilar amigdalino y paladar), disección de la mucosa y del tumor de los planos profundos, traccionándolo hacia la cavidad oral. Para disecar el límite superior (rinofaringe) y lateral se utilizaron endoscopios que fueron introducidos por la incisión y por la cavidad nasal. El abordaje transnasal consistió en realizar una incisión en la pared lateral de la rinofaringe y disecar el tumor del plano profundo traccionándolo hacia el cavum. Resultados: Fueron tratados 3 pacientes por vía transoral y uno por vía endonasal por padecer tumores del espacio parafaríngeo. Tres tumores se originaron en glándulas salivales menores localizadas una en el espacio. Preestiloideo (1/3), otra en el espacio masticador (1/3) y otra en el sector superior del espacio preestiloideo (1/3). La histología dio como resultado dos adenoma pleomorfo y un carcinoma mucoepidermoide de bajo grado (1/3). (Está bien así? Qué es 1/3?). Una neoplasia se originó en el lóbulo profundo de la parótida y se extendió al espacio preestiloideo, su histología fue carcinoma mucoepidermoide de grado moderado. Conclusiones: La tasa de resección completa en pacientes con tumores del espacio parafaríngeo seleccionados tratados por vía transoral y endonasal fue del 100%. (AU)

Objectives: To determine the rate of complete surgical resection in parapharyngeal space selected tumors treated with transoral and / or transnasal approach. Design: Descriptive, retrospective. Materials and methods: Patients who had tumors localized in parapharyngealspace and who were treated with transoral or transnasal surgery. were included in this study. The transoral approach consisted in performing an incision with cautery in the area of greates tumor protrusion (tonsillar pillar and palate), dissection of the mucosa and tumor of the deep planes, pulling it into the oral cavity. To dissect the upper limit (nasopharynx) and lateral we used endoscopes that were inserted by the incision and the nasal cavity. The transnasal approach consisted in making an incision in the side wall of the nasopharynx and dissect the tumor of the deep plane pulling it towards the cavum. Results: Three patients were treated with transoral and one byendonasalapproacheswho had parapharyngeal space tumors. Three tumors originated in minor salivary glands located in prestyloidspace (1/3), masticator space (1/3) and upper sector of pree-styloid space (1/3). Histology was in two pleomorphic adenoma, and another onelow degree mucoepidermoid carcinoma (1/3). A neoplasm was originated in the deep lobe of the parotid gland and was extended to the prestyloid space, was a moderate degree of mucoepidermoid carcinoma. Conclusions: Complete resection rate in patients with selected parapharyngeal space tumors, treated by transorally and endonasal approach was 100%. (AU)

Anatomical sign of parapharyngeal space operation via endoscopy-assisted transoral approach / 局解手术学杂志

Objective To observe the anatomical constant sign of the parapharyngeal space operation via endoscopy-assisted transoral approach,and provide evidence for the treatment of the lesions of the pharyngeal space and improve the success rate of the operation. Methods CT multi plane reconstruction and three dimensional reconstruction were performed on 10 fresh dead bodies who were acquired from January 2015 to September 2015,the structure of the lateral pharyngeal space was observed,and the parapharyngeal space operation was performed via endoscopy-assisted transoral approach.Results The CT images showed that dispharynx of very low density extended posterior-lateral into the pharyngeal recess,lateral pharyngeal space located in the lateral pharyngeal recess,a low density triangular shadow with a nar-row of the front and width in the back,wing within muscles,wing outside muscles,masseter and temporal muscle located in the lateral pharyn-geal side clearance,which showed a medium density shadow,styloid process located in the front shadow of pharynx side clearance,the back of the internal carotid artery of pharynx side clearance,which showed medium density shadow.The blood vessels in the pharyngeal space and the nerve development was not clear.Stem styloid located in the temporal bone of the skull base drum subordinates,with length of (24.98 ± 2.01)mm,the internal structures of parapharyngeal space located in styloid process and around the surface of the deep muscular,the outside of styloid process had external carotid artery,facial nerve and mastoid.Inside of the base of styloid process had jugular vein foramen and hypo-glossal canal outside hole,the front inner side had carotid canal outside hole,the foramen spinosum,and oval foramen,the rear with stem hole.The distance between left and right side of root of styloid process to adjacent structures was compared,and the difference had no statisti-cal significance(P >0.05).In addition to the root of the styloid process to stylomastoid foramen.The difference of root of styloid process of males to adjacent structure was greater than that of the females,the difference had statistical significance(P <0.05).Conclusion Endo-scopic-assisted transoral approach to the parapharyngeal space operation hasthe styloid process as the marks of anatomy,the distance of styloid process to adjacent anatomical structures is as the reference,which helps to find and identify the parapharyngeal space of peripheral nerve, blood vessel,etc.

Wernicke's encephalopathy in a patient with masticator and parapharyngeal space abscess: a case report

Wernicke's encephalopathy is a fatal neurological disease caused by thiamine deficiency. Many reports indicate that Wernicke's encephalopathy is caused by malnutrition. We report the case of a 79-year-old female patient who had a left masticator space and parapharyngeal space abscess who was diagnosed with Wernicke's encephalopathy. She reported problems while eating due to the presence of the abscess, but the true quantities of food she was ingesting were never assessed. Clinicians have a responsibility to provide adequate nutritional support by ensuring that patients receive adequate nutrition. Clinicians should also keep in mind that Wernicke's encephalopathy may occur in patients who experienced prolonged periods of malnutrition.

Tumores del espacio parafaríngeo: revisión del tema / Parapharyngeal space tumors: review

Los tumores del espacio parafaríngeo son poco frecuentes, por lo tanto existe experiencia publicada limitada respecto a su diagnóstico y tratamiento. Por este motivo, representan un reto diagnóstico y terapéutico. En la mayoría de los casos se puede llegar a un diagnóstico con una adecuada anamnesis, examen físico, imagenología, y complementando con punción aspirativa con aguja fina. La diferenciación entre un tumor preestiloídeo de uno retroestiloídeo es fundamental para orientar el diagnóstico diferencial. El tratamiento de elección es la escisión quirúrgica, advirtiendo al paciente las posibles vías de abordaje, la comorbilidad asociada a cada una de estas vías, sobre todo a nivel de función de nervios craneanos, y la eventual necesidad de coadyuvancia en caso de requerirse.

Parapharyngeal space tumors are rare, so there is limited published experience regarding their diagnosis and treatment. Therefore, they represent a diagnostic and therapeutic challenge. In most cases, diagnosis can be made with an adequate anamnesis, physical examination, imaging, and the use of fine needle aspiration. Differentiation between prestyloid and poststyloid tumor is a key to guiding the differential diagnosis. The treatment of choice is surgical excision, warning the patient the possible surgical approaches, comorbidity associated with each of these pathways, especially at the level of function of cranial nerves, and the eventual need of coadjuvant treatment if required.

Imaging findings of deep-lobe parotid tumors involving the parapharyngeal space / 实用放射学杂志

Objective To analyze the imaging appearances of the deep-lobe parotid tumors involving the parapharyngeal space (PPS).Methods The CT and MRI data of 23 cases with deep-lobe parotid tumors involving PPS were analyzed retrospectively.The neoplasms included pleomorphic adenomas (n=1 9),basal cell adenomas (n =2),neurilemmomas(n = 1 )and malignant myoepi-thelioma(n=1).Results The lesions presented as oval(n=1 7)or irregular (n =6)masses.None of the 23 cases showed visible fat space between the tumors and deep-lobe of parotid glands.Fat Cap Sign was found in 9 cases.Parotid Pedicle Sign was demonstrated in 8 cases.The styloids were displaced posteriorly(n=4)or surrounded(n=4)by the tumors.Five masses were found to be situated at the superficial side to the posterior belly of the digastric muscle.Carotid sheaths were shifted anteromedially (n=7)or postero-medially(n= 1 1 )by the tumors.Conclusion The deep-lobe parotid tumors involving PPS have some imaging features which are helpful in the differential diagnosis between the deep-lobe parotid tumors and PPS primary tumors.

A Case of Cavernous Hemangioma in the Parapharyngeal Space as a Neurogenic Tumor / 대한이비인후과학회지

Hemangiomas are the most common benign neoplasms, which frequently involve the region of head and neck. However, cavernous hemangiomas are extremely rare in the parapharyngeal space and there has been only a few case reports regarding the disease found in this region. Recently, we experienced a 57-year-old female patient with cavernous hemangioma involving the infratemporal fossa and parapharyngeal space. This case was surgically managed using the infratemporal fossa approach type B. Preoperatively, it was difficult to differentiate the mass of cavernous hemangioma from a neurogenic tumor and this led to a massive bleeding during the operawtion. The preoperative decision-making process and the role of diagnostic imaging were discussed with literature reviews.