Microsurgery in primary tumors of the parapharyngeal space: observational retrospective analysis of a series of consecutive cases| ACTA Otorhinolaryngologica Italica

Abstract

Objective: To investigate safety and efficacy of the microsurgical approach to parapharyngeal space (PPS) tumor. A secondary goal was to evaluate the correspondence between preoperative diagnosis and surgical procedure.

Methods: a consecutive series of primary PPS tumors, treated with a microsurgical cervico-parotid approach was considered. The sample included 97 tumors (88 benign and 9 malignant) in 94 patients. The surgical approaches, planned based on the presumptive preoperative diagnosis, were pericapsular resection and en bloc resections (including either conservative or radical resections of the PPS).

Results: pericapsular and en bloc resections of the PPS achieved complete removal in 88 out of 97 tumors. Recurrence occurred only in 9 cases (4 pleomorphic adenomas, 1 melanoma, 1 hemangiopericytoma, 1 rhabdomyoma and 2 malignant schwannomas).

A complete correspondence between preoperative diagnosis and final histology occurred only in the group of benign lesions classified as paraganglioma, schwannoma, or lipoma, submitted to pericapsular resection.

Conclusions: Microsurgery may support the cervico-parotid approach, by enhancing the operative space through narrow surgical corridors, improving dissection on critical cleavage planes, vessels and nerves, allowing the exposure of both caudal and cranial extent of the lesions. In our series, pericapsular and en bloc resections of the PPS were effective in most of the included patients. In high-grade malignancies, where the morbidity of a wider resection beyond the PPS walls may include vessels and nerves, the indication should be accurately balanced.