Parapharyngeal space tumors: Diagnosis and surgical management

ABSTRACT

Forty three patients presenting with parapharyngeal space [PPS] tumors were studied. Diagnosis was based on history, physical examination and imaging procedures [C. T scan, MRI, MRA, metastatic workup and fine needle aspiration cytology [FNAC] under C. T or U.S guidance]. Surgical approaches used for treatment included transcervical, transparotid, transcervical-transparotid, transcervical-transmandibular and transmaxillary. Most patients [90.7%] presented with cervical mass. Pain was present in 8 patients, tongue paresis in 6 patients, and dysarthria in 5 patients.C. T scan was done for all patients, MRI was done for 16 patients and MRA was done for 7 patients. Angiography was done for 3 patients and balloon occlusion test was done for 2 patients. FNAC was done in 19 patients. Surgical resection was done for all patients in the form of wide local excision of the tumor. Transcervical approach was used in 14 patients, transparotid cervical in 11 patients, mandibular swing in 7 patients. Temporary tracheostomy was done in 16 patients, ipsilateral neck dissection in 3 patients. Two patients required pectoralis major myocutaneous flap and 3 needed free flaps for wound closure. Recurrence occurred in 3/32 benign cases with reoperation and no recurrence later. 6/11 malignant cases presented with recurrence 2 needed reoperation while the rest treated by chemo or radiotherapy. Management of PPS tumors is a challenge because of the complexity of the space and different histological types of the lesions. Proper diagnosis as well as different surgical approaches according to the location of the lesion can provide complete resection with satisfactory outcome: