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Parapharyngeal Space
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Lesions of the parapharyngeal space are predominantly treated by surgery. The aim of surgery is to remove the lesion with minimal morbidity. Adjuvant radiotherapy is reserved for malignant lesions or recurrent benign lesions with a high risk of recidivism. Chemotherapy is administered when indicated by specific histology, such as rhabdomyosarcoma, positive margin status, tumour histology, and perineural and lympho-vascular spread. Radiotherapy has also been used in patients who are considered a high surgical risk or for unresectable lesions.
Head and Neck Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Lorcan O’Toole, Nicholas D. Stafford
The nasopharynx is difficult to assess clinically. CT scanning and MRI are essential to obtain accurate anatomical information about the primary and its spread. Most tumors originate in the fossa of Rosenmuller, and the earliest radiological sign is blunting of the angle at the Eustachian cushion. CT scanning has highlighted the importance of spread into the parapharyngeal space which cannot be assessed clinically. Around 30% of patients with clinically negative necks will have occult nodal involvement on imaging, which will also demonstrate involvement of the skull base in approximately 35% of cancers.
Anatomy and differential diagnosis in head and neck surgery
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
The retropharyngeal space runs from the base of skull to the thorax along the vertebra. It is anterior to the danger space. The space is directly posterior to the pharyngeal mucosal space. It lies anteromedial to the carotid space and posteromedial to the parapharyngeal space.
Transcervical endoscopic approach for parapharyngeal space: a cadaver study and clinical practice
Published in Acta Oto-Laryngologica, 2020
Yi Fang, Haitao Wu, Andrew D. Tan, Lei Cheng
The parapharyngeal space (PPS) is one of the most complex anatomical regions in the head and neck. The styloid process and fascia derived from the styloid related muscle divide the PPS into prestyloid and poststyloid compartments [1]. Providing access for pathology in this deep-seated space has been an extreme challenge because access is constricted by the mandible, maxilla, and zygoma. The traditional surgical approaches contain either transoral, transcervical, transmandibular, transparotid approaches or a combination of these approaches. Of these approaches, the traditional transcervical approach is applied most frequently [2–4]. However, this approach is still limited in its inability to expose the superior aspect of the PPS, for the lack of direct visualization. Poor optical corridor contributes to the morbidity by the injury of the vessels and nerves traveling the through parapharyngeal space including vagus nerves and branches of the glossopharyngeal nerve. One of the most disastrous complications of parapharyngeal surgery is the injury of internal carotid artery (ICA), as tumors adjacent to ICA and skull base are difficult to be safely dissected without any vascular injury [5]. Thus, a complete and systematic anatomic acquaintance of the parapharyngeal ICA and following cranial nerves is a rate-limiting step in any attempt to minimize complications.
Transnasal drainage prevents surgical cavity related complications in transoral robotic surgery resected parapharyngeal space tumors
Published in Acta Oto-Laryngologica, 2023
Chunping Wu, Chengzhi Xu, Huiching Lau, Xiaoling Shi, Quan Liu, Liang Zhou, Lei Tao
Increasing studies of parapharyngeal space (PPS) tumors resected by transoral robotic surgery (TORS) have been reported and the overall incidence of postoperative complications ranged from 12% to 29% [1]. The most common postoperative complication is dysphagia (4.5%). Other less common complications include hemorrhage/hematoma formation in the surgical cavity (3.6%), infection/phlegmon in the surgical cavity (0.9%), Horner’s syndrome (2.7%), pharyngeal dehiscence (1.8%), trismus (1.8%), first bite syndrome (1.8%), vocal cord palsy/laryngeal paralysis (1.8%), and cervical emphysema (0.9%) [1–3]. Some complications are related to the surgical cavity, such as hemorrhage/hematoma formation, effusion, and infection/phlegmon, which we call surgical cavity related complications (SCRC).
Surgical management of primary parapharyngeal space tumors in 103 patients at a single institution
Published in Acta Oto-Laryngologica, 2018
Fenglin Sun, Yan Yan, Dongmin Wei, Wenming Li, Shengda Cao, Dayu Liu, Guojun Li, Xinliang Pan, Dapeng Lei
The parapharyngeal space (PPS) is a deep neck space in the lateral pharyngeal region. The PPS is in the shape of an inverted pyramid, with the greater cornu of the hyoid bone as its apex and the skull base as its floor [1]. It is divided into an anterior muscular compartment and a posterior neurovascular compartment by muscular aponeurotic partition [2]. A wide spectrum of benign and malignant primary pathologies has been encountered in this complex anatomic region.