Objective Traditionally tumors of the parapharyngeal space(PPS)are resected through transcervical approaches.More recent approaches include endoscopic approaches or transoral robotic surgery(TORS)without directions on...Objective Traditionally tumors of the parapharyngeal space(PPS)are resected through transcervical approaches.More recent approaches include endoscopic approaches or transoral robotic surgery(TORS)without directions on when to use which approach.Our objective was to find objective parameters to choose the most suitable approach.Methods It is a retrospective study containing 6 patients from May 2019 to May 2021 with tumors of the PPS treated in the Department of Otolaryngology and Head-Neck Surgery at the Hospital of Lucerne,Switzerland.Results The data was analysed in average 53 months after surgery.Tumor resection was completed with TORS in 3 patients and endoscopically in 3 patients.Mean operation time was 114 min.No major complications occurred.No evidence of tumor was found in magnetic resonance imaging studies postoperatively in all patients.Conclusion We conclude that a resection via TORS or endoscopic technique is safe and effective.Furthermore,we postulate that the further a tumor is located in the upper lateral area of the PPS,an approach via TORS is less possible.展开更多
Two hundred cates of nasopharyngeal carcinoma (NPC) admitted to this department from Feb. 1985 to May. 1988 were analysed according to the CT scanning and clinical findings of the primary lesions prior to radiotherapy...Two hundred cates of nasopharyngeal carcinoma (NPC) admitted to this department from Feb. 1985 to May. 1988 were analysed according to the CT scanning and clinical findings of the primary lesions prior to radiotherapy. The results showed that involvement of parapharyngeal space was very common in NPC, about 80% (160/200 cases) ; particularly unilateral or bilateral retro-styloid spaces, about 69.5% (139/200 cases). It was proposed that patients with NPC had a high Incidence of ipsilateral cervical node metastasis. Contralateral cervical node metastasis was rare. The development of cervical node metastasto in NPC has two modes: one Is direct Infiltration of the retro-stylold space by the lesion; the other Is along the nasopharyngeal lymphatic rete. The data also showed that patients with NPC who presented symptoms of Ⅸ- Ⅲ cranial nerve paralyses always had ipsilateral or bilateral retro- styloid space Infiltrations.展开更多
BACKGROUND Solitary fibrous tumors(SFTs)occurring in the parapharyngeal space are rare,and their final diagnosis depends on pathological and immunohistochemical analyses.Once the tumor is diagnosed,complete resection ...BACKGROUND Solitary fibrous tumors(SFTs)occurring in the parapharyngeal space are rare,and their final diagnosis depends on pathological and immunohistochemical analyses.Once the tumor is diagnosed,complete resection and regular postoperative follow-up are required.CASE SUMMARY A 40-year-old male patient with a right parotid gland mass discovered 8 years ago was admitted to hospital.The mass showed no tenderness or local skin redness.Imaging was carried out as the patient had stable vital signs and showed that the mass was a dumbbell-shaped tumor comprising a superficial tumor approximately 5 cm long and 3 cm wide in size that compressed the right parotid gland and a deep tumor located in the right parapharyngeal space approximately 4.5 cm long and 2.5 cm wide in size.Both tumors were connected in the middle.Prior to surgery,the tumors were considered to be parapharyngeal schwannomas.During surgical dissection,the tumors were found to be smooth and tough,without obvious adhesion to the surrounding tissues.The tumors were revealed to be a SFT following postoperative pathological analysis.CONCLUSION SFTs in the parapharyngeal space are rarely reported,and complete resection of such tumor is recommended.Adjuvant chemoradiotherapy is used in patients with extensive tumor invasion to lower the recurrence rate.Postoperative longterm follow-up is required.展开更多
Most of the parapharyngeal space tumours are benign.The primary treatment is complete resection of the tumour.Due to its location in the deep neck space,a pre-styloid tumour can be resected via the transoral approach....Most of the parapharyngeal space tumours are benign.The primary treatment is complete resection of the tumour.Due to its location in the deep neck space,a pre-styloid tumour can be resected via the transoral approach.However,the surgical field is limited by the small oral cavity.With the use of rigid endoscopes,removing benign tumours through transoral approach in the parapharyngeal space is possible as they provide a broad and enlarged view of the confined space.Here,we report a case of a 64-year-old male with a giant pre-styloid parapharyngeal space tumour,who successfully underwent transoral endoscopic excision.Postoperatively,the patient had short hospital stay of total 3 days.His chewing and swallowing were not affected,and he resumed oral feeding prior to discharge.展开更多
Background:Several approaches have been described for the excision of parapharyngeal space tumors(PPSTs).Advances in endoscopy gave a further stimulus to the use of the transoral route.Aims:We present our experience w...Background:Several approaches have been described for the excision of parapharyngeal space tumors(PPSTs).Advances in endoscopy gave a further stimulus to the use of the transoral route.Aims:We present our experience with the endoscopy-assisted transoral approach(EATA)in this regard and a review of the most recent literature about EATA for PPSTs excision.Materials and Methods:We retrospectively analyzed our experience and systematically reviewed the literature about the outcomes of this technique.Results:Seven PPSTs were completely excised,with three of them requiring a combined transcervical approach.Only one case of postoperative wound dehiscence was registered,and the mean length of stay was 3.9 days.Final histopathological examination confirmed the results obtained with preoperative fine-needle aspiration biopsy in all cases and no recurrences were apparent after a mean follow-up of 28.1 months.Discussion:Magnetic resonance imaging,the modified Mallampati score and the 8 Ts criteria are useful instruments for the choice of the most appropriate surgical approach.Conclusion:In light of our experience and following other published series in the literature,we believe that EATA may represent a safe and effective approach for the treatment of the majority of PPSTs.展开更多
BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The id...BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The ideal modality of treatment has always been surgical excision irrespective of the site and age group.But with the advent of minimally invasive surgical techniques,it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside,where Transcervical approach was attempted to remove the parapharyngeal mass,but failed.Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass.He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature.The symptoms of the patient with large parapharyngeal mass include dysphagia,dyspnoea and neck swelling.Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor.With the advent of robotics in oncology,transoral robotic excision is one of the best approaches to perform such a surgery.展开更多
Objective:Parapharyngeal space contains intricate vascular anatomy(external and internal carotid arteries)that might be inadvertently injured during the dissection in this plane.None of the bony landmarks can be used ...Objective:Parapharyngeal space contains intricate vascular anatomy(external and internal carotid arteries)that might be inadvertently injured during the dissection in this plane.None of the bony landmarks can be used during the transoral robotic surgery(TORS)radical tonsillectomy as these landmarks lie lateral to the internal carotid artery(ICA)and external carotid artery(ECA)in transoral approach.Our study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological study.Material and methods:Fifteen cadavers(30 head and neck regions)and 50 CT-Angiogram of neck(100 head and neck regions)were included in the anatomical and radiological study respectively.The vertical midpoint of anterior tonsillar pillar(palatoglossus muscle)was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological study.Distance between tonsillar fossa and ECA,distance between tonsillar fossa and ICA,relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were studied.Results:The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological study.The mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological study.There was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa(p value was 0.45 and 0.30 respectively).ECA was located posterolateral to styloglossus in 24 cases(80.0%)and 79 cases(79.0%)in the anatomical and radiological study respectively.ICA was found posterolateral to stylopharyngeus in 21 cases(70.0%)and 69 cases(69.0%)in the anatomical and radiological study respectively.Conclusion:The muscular plane between styloglossus and stylopharyngeus can be used as an envelope to locate the ECA and ICA that lie medial to these critical vascular structures during TORS.We propose to divide the parapharyngeal space into two compartments(anterior and posterior)based on the surgical perspective of inside-out anatomy.The anterior compartment houses styloglossus muscle with ECA posterolateral to it and the posterior compartment has stylopharyngeus and ICA posterolateral to it.展开更多
文摘Objective Traditionally tumors of the parapharyngeal space(PPS)are resected through transcervical approaches.More recent approaches include endoscopic approaches or transoral robotic surgery(TORS)without directions on when to use which approach.Our objective was to find objective parameters to choose the most suitable approach.Methods It is a retrospective study containing 6 patients from May 2019 to May 2021 with tumors of the PPS treated in the Department of Otolaryngology and Head-Neck Surgery at the Hospital of Lucerne,Switzerland.Results The data was analysed in average 53 months after surgery.Tumor resection was completed with TORS in 3 patients and endoscopically in 3 patients.Mean operation time was 114 min.No major complications occurred.No evidence of tumor was found in magnetic resonance imaging studies postoperatively in all patients.Conclusion We conclude that a resection via TORS or endoscopic technique is safe and effective.Furthermore,we postulate that the further a tumor is located in the upper lateral area of the PPS,an approach via TORS is less possible.
文摘Two hundred cates of nasopharyngeal carcinoma (NPC) admitted to this department from Feb. 1985 to May. 1988 were analysed according to the CT scanning and clinical findings of the primary lesions prior to radiotherapy. The results showed that involvement of parapharyngeal space was very common in NPC, about 80% (160/200 cases) ; particularly unilateral or bilateral retro-styloid spaces, about 69.5% (139/200 cases). It was proposed that patients with NPC had a high Incidence of ipsilateral cervical node metastasis. Contralateral cervical node metastasis was rare. The development of cervical node metastasto in NPC has two modes: one Is direct Infiltration of the retro-stylold space by the lesion; the other Is along the nasopharyngeal lymphatic rete. The data also showed that patients with NPC who presented symptoms of Ⅸ- Ⅲ cranial nerve paralyses always had ipsilateral or bilateral retro- styloid space Infiltrations.
文摘BACKGROUND Solitary fibrous tumors(SFTs)occurring in the parapharyngeal space are rare,and their final diagnosis depends on pathological and immunohistochemical analyses.Once the tumor is diagnosed,complete resection and regular postoperative follow-up are required.CASE SUMMARY A 40-year-old male patient with a right parotid gland mass discovered 8 years ago was admitted to hospital.The mass showed no tenderness or local skin redness.Imaging was carried out as the patient had stable vital signs and showed that the mass was a dumbbell-shaped tumor comprising a superficial tumor approximately 5 cm long and 3 cm wide in size that compressed the right parotid gland and a deep tumor located in the right parapharyngeal space approximately 4.5 cm long and 2.5 cm wide in size.Both tumors were connected in the middle.Prior to surgery,the tumors were considered to be parapharyngeal schwannomas.During surgical dissection,the tumors were found to be smooth and tough,without obvious adhesion to the surrounding tissues.The tumors were revealed to be a SFT following postoperative pathological analysis.CONCLUSION SFTs in the parapharyngeal space are rarely reported,and complete resection of such tumor is recommended.Adjuvant chemoradiotherapy is used in patients with extensive tumor invasion to lower the recurrence rate.Postoperative longterm follow-up is required.
文摘Most of the parapharyngeal space tumours are benign.The primary treatment is complete resection of the tumour.Due to its location in the deep neck space,a pre-styloid tumour can be resected via the transoral approach.However,the surgical field is limited by the small oral cavity.With the use of rigid endoscopes,removing benign tumours through transoral approach in the parapharyngeal space is possible as they provide a broad and enlarged view of the confined space.Here,we report a case of a 64-year-old male with a giant pre-styloid parapharyngeal space tumour,who successfully underwent transoral endoscopic excision.Postoperatively,the patient had short hospital stay of total 3 days.His chewing and swallowing were not affected,and he resumed oral feeding prior to discharge.
文摘Background:Several approaches have been described for the excision of parapharyngeal space tumors(PPSTs).Advances in endoscopy gave a further stimulus to the use of the transoral route.Aims:We present our experience with the endoscopy-assisted transoral approach(EATA)in this regard and a review of the most recent literature about EATA for PPSTs excision.Materials and Methods:We retrospectively analyzed our experience and systematically reviewed the literature about the outcomes of this technique.Results:Seven PPSTs were completely excised,with three of them requiring a combined transcervical approach.Only one case of postoperative wound dehiscence was registered,and the mean length of stay was 3.9 days.Final histopathological examination confirmed the results obtained with preoperative fine-needle aspiration biopsy in all cases and no recurrences were apparent after a mean follow-up of 28.1 months.Discussion:Magnetic resonance imaging,the modified Mallampati score and the 8 Ts criteria are useful instruments for the choice of the most appropriate surgical approach.Conclusion:In light of our experience and following other published series in the literature,we believe that EATA may represent a safe and effective approach for the treatment of the majority of PPSTs.
文摘BACKGROUND Lymphangiomas are a group of benign swellings which are commonly seen in children.The most common sites of presentation is the head and neck region,less commonly seen in axilla,chest,liver,spleen,etc.The ideal modality of treatment has always been surgical excision irrespective of the site and age group.But with the advent of minimally invasive surgical techniques,it is now possible to perform excision of parapharyngeal space lesions with minimal morbidity and good clearance.CASE SUMMARY A 42-year-old male patient who presented with difficulty in swallowing and had undergone surgery twice outside,where Transcervical approach was attempted to remove the parapharyngeal mass,but failed.Magnetic resonance imaging scan demonstrated a 6 cm x 5 cm x 4 cm left parapharyngeal mass.He underwent transoral robotic surgery for the excision of the parapharyngeal lesion and had an uneventful post-operative recovery.CONCLUSION Lymphangiomas are hamartomatous swellings which are benign in nature.The symptoms of the patient with large parapharyngeal mass include dysphagia,dyspnoea and neck swelling.Clinicoradiological evaluation is of utmost importance to determine the adjacent vital structures and the approach to the tumor.With the advent of robotics in oncology,transoral robotic excision is one of the best approaches to perform such a surgery.
文摘Objective:Parapharyngeal space contains intricate vascular anatomy(external and internal carotid arteries)that might be inadvertently injured during the dissection in this plane.None of the bony landmarks can be used during the transoral robotic surgery(TORS)radical tonsillectomy as these landmarks lie lateral to the internal carotid artery(ICA)and external carotid artery(ECA)in transoral approach.Our study aims to identify the safe surgical limits during the dissection of parapharyneal space in TORS radical tonsillectomy and to correlate the same with radiological study.Material and methods:Fifteen cadavers(30 head and neck regions)and 50 CT-Angiogram of neck(100 head and neck regions)were included in the anatomical and radiological study respectively.The vertical midpoint of anterior tonsillar pillar(palatoglossus muscle)was taken as the reference point and all the measurements were done at the level of reference point both for anatomical and radiological study.Distance between tonsillar fossa and ECA,distance between tonsillar fossa and ICA,relation between ECA and styloglossus and relation between ICA and stylopharyngeus at reference level were studied.Results:The mean distance of ECA from the tonsillar fossa at the reference point was 18.2 mm in the anatomical study and 16.2 mm in the radiological study.The mean distance of ICA from the tonsillar fossa was 23.4 mm and 23.3 mm in the anatomical study and radiological study.There was no significant difference between the anatomical and radiological findings for both the mean distance between ECA and ICA to the tonsillar fossa(p value was 0.45 and 0.30 respectively).ECA was located posterolateral to styloglossus in 24 cases(80.0%)and 79 cases(79.0%)in the anatomical and radiological study respectively.ICA was found posterolateral to stylopharyngeus in 21 cases(70.0%)and 69 cases(69.0%)in the anatomical and radiological study respectively.Conclusion:The muscular plane between styloglossus and stylopharyngeus can be used as an envelope to locate the ECA and ICA that lie medial to these critical vascular structures during TORS.We propose to divide the parapharyngeal space into two compartments(anterior and posterior)based on the surgical perspective of inside-out anatomy.The anterior compartment houses styloglossus muscle with ECA posterolateral to it and the posterior compartment has stylopharyngeus and ICA posterolateral to it.
