Advances in Surgical Sciences

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Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours

Received: 08 December 2019    Accepted: 08 January 2020    Published: 07 February 2020
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Abstract

Parapharyngeal space tumours are rare, mostly benign and present few symptoms, being difficult to diagnose it early. CT scan and MR are necessary for topographical diagnosis. Surgical resection is the best possible treatment option, but the approach remains a challenge, as there are several vital elements contained in the parapharyngeal space and, thus, adequate visualization is needed. Different surgical approaches have been described: transcervical-submandibular, transparotid, transmandibular, transoral and combined approaches. Transoral approach is the most controversial one due to cited limited exposure, which can lead to neurovascular injury or incomplete removal of the lesion. It is seldom performed and only for small, extra-parotid and non-vascular tumours of the parapharyngeal space. Wide access to endoscopic equipment in our institute allowed us to perform medium to large benign parapharyngeal tumour resection usig the transoral approach. The use of endoscopic assistance for transoral approach provided direct and magnified visualization of the parapharyngeal space, reducing tissue damage, ensuring adequate hemostasis (which lead to less amount of bleeding) and also confirming complete resection prior to closure. In addition, compared to transcervical approach, transoral approach shortened hospitalization time and improved cosmetic appearance. Benign parapharyngeal space tumours not involving critical structures from the parapharyngeal space can be completely resected by an endoscopic-assisted transoral approach with good functional and cosmetic outcome.

DOI 10.11648/j.ass.20200801.12
Published in Advances in Surgical Sciences (Volume 8, Issue 1, June 2020)
Page(s) 5-10
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Parapharyngeal, Transoral, Endoscopic

References
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[2] Suarez-Fente V, Llorente-Pendas JL, Gomez-Martinez J, Garcia-Gonzalez LA, Lopez-Alvarez F, Suarez-Nieto C., Primary tumours of the parapharyngeal space. Our experience in 51 patients, Acta Otorrinolaringol Esp., 2009, Jan. 60 (1): 19-24.
[3] Gourin CG. Johnson JT, Parapharyngeal space tumors, september 2011, http:/emedicine.medscape.com/article/849385-overview#a0102.
[4] Carrau RL, Myers EN, Johnson JT, Laryngoscope, 100 (1990) 583.
[5] Parapharyngeal Space Tumors, Christopher D Pool, Neerav Goyal, 2019, https://emedicine.medscape.com/article/849385-overview.
[6] Marijan Kovajcic, Milan Rudic and Zoran Kranjcec, Transoral Excision of a Parapharyngeal Space Tumor: Case Report, Coll. Antropol. 36 (2012) Suppl. 2: 193–195.
[7] Pradeep Pradhan, Chappity Preetam, Pradipta Kumar Parida et al. Surgical Management of Parapharyngeal Space Tumours in a Single Tertiary Care Center, Indian J Otolaryngol Head Neck Surg. 2018 Dec; 70 (4): 531–537.
[8] The Open Access Atlas of Otolaryngology, Head & Neck Operative Surgery by Johan Fagan/ johannes.fagan@uct.ac.za.
[9] Stell PM, Mansfield AO, Stoney PJ. Surgical approaches to tumors of the parapharyngeal space. Am J Otolaryngology 1985; 6: 92–7.
[10] Pensak ML, Gluckman JL, Sumrick KA. Parapharyngeal space tumors: an algorithm for evaluation and management. Laryngoscope 1994; 104: 1170 –3.
[11] Olsen KD. Tumors and surgery of the parapharyngeal space. Laryngoscope 1994; 104: 1–27.
[12] Kuet ML, Kasbekar AV, Masterson L, et al. Management of tumors arising from the parapharyngeal space: a systematic review of 1,293 cases reported over 25 years. Laryngoscope 2015; 125 (6): 1372–1381.
[13] Cohen SM, Burke BB, Netterville JL (2005) Surgical Management of Parapharyngeal Space Masses. Head Neck 27 (8): 669-675.
[14] Goodwin WJ, Chandler JR (1988) Transoral excision of lateral parapharyngeal space tumors presenting intraorally. Laryngoscope 98 (3): 266-269.
[15] Chan JY, Tsang RK, Eisele DW, Richmon JD. Transoral robotic surgery of the parapharyngeal space: a case series and systematic review. Head Neck. 2015 Feb. 37 (2): 293-8.
[16] O'Malley BW Jr, Quon H, Leonhardt FD, Chalian AA, Weinstein GS. Transoral robotic surgery for parapharyngeal space tumors. ORL J Otorhinolaryngol Relat Spec. 2010. 72 (6): 332-6.
[17] Duek I, Amit M, Sviri GE, Gil Z. Combined endoscopic transcervical-transoral robotic approach for resection of parapharyngeal space tumors. Head Neck. 2017 Apr. 39 (4): 786-90.
[18] Fan S, Lin SG, Zhang HQ, et al. A comparative study of the endoscopy-assisted transoral approach versus external approaches for the resection of large benign parapharyngeal space tumors. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Feb. 123 (2): 157-62.
[19] Sanjay Helale, Preety Ninan and Abhishek Kumar Ramadhin, Endoscope-Assisted Transoral Approach to Parapharyngeal Space Tumor: A Case Report, Journal of Otolaryngology-ENT Research, Volume 2 Issue 3 – 2015.
[20] Riffat F, Dwivedi RC, Palme C, Fish B, Jani P. A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral Oncol 2014; 50 (05): 421–430.
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Author Information
  • Institute of Phonoaudiology and Functional ENT Surgery “Dorin Hociot?”, Bucharest, Romania

  • Institute of Phonoaudiology and Functional ENT Surgery “Dorin Hociot?”, Bucharest, Romania

  • Institute of Phonoaudiology and Functional ENT Surgery “Dorin Hociot?”, Bucharest, Romania

  • Institute of Phonoaudiology and Functional ENT Surgery “Dorin Hociot?”, Bucharest, Romania; Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

  • Institute of Phonoaudiology and Functional ENT Surgery “Dorin Hociot?”, Bucharest, Romania

Cite This Article
  • APA Style

    Ștefan Iemima, Tonu Angela, Ghiță Dragoș, Ivodii Mirela, Othieno Theresa Mary, et al. (2020). Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours. Advances in Surgical Sciences, 8(1), 5-10. https://doi.org/10.11648/j.ass.20200801.12

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    ACS Style

    Ștefan Iemima; Tonu Angela; Ghiță Dragoș; Ivodii Mirela; Othieno Theresa Mary, et al. Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours. Adv. Surg. Sci. 2020, 8(1), 5-10. doi: 10.11648/j.ass.20200801.12

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    AMA Style

    Ștefan Iemima, Tonu Angela, Ghiță Dragoș, Ivodii Mirela, Othieno Theresa Mary, et al. Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours. Adv Surg Sci. 2020;8(1):5-10. doi: 10.11648/j.ass.20200801.12

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  • @article{10.11648/j.ass.20200801.12,
      author = {Ștefan Iemima and Tonu Angela and Ghiță Dragoș and Ivodii Mirela and Othieno Theresa Mary and Zainea Viorel and Rădulescu Marian and Marinescu Andreea and Hainăroșie Răzvan},
      title = {Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours},
      journal = {Advances in Surgical Sciences},
      volume = {8},
      number = {1},
      pages = {5-10},
      doi = {10.11648/j.ass.20200801.12},
      url = {https://doi.org/10.11648/j.ass.20200801.12},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ass.20200801.12},
      abstract = {Parapharyngeal space tumours are rare, mostly benign and present few symptoms, being difficult to diagnose it early. CT scan and MR are necessary for topographical diagnosis. Surgical resection is the best possible treatment option, but the approach remains a challenge, as there are several vital elements contained in the parapharyngeal space and, thus, adequate visualization is needed. Different surgical approaches have been described: transcervical-submandibular, transparotid, transmandibular, transoral and combined approaches. Transoral approach is the most controversial one due to cited limited exposure, which can lead to neurovascular injury or incomplete removal of the lesion. It is seldom performed and only for small, extra-parotid and non-vascular tumours of the parapharyngeal space. Wide access to endoscopic equipment in our institute allowed us to perform medium to large benign parapharyngeal tumour resection usig the transoral approach. The use of endoscopic assistance for transoral approach provided direct and magnified visualization of the parapharyngeal space, reducing tissue damage, ensuring adequate hemostasis (which lead to less amount of bleeding) and also confirming complete resection prior to closure. In addition, compared to transcervical approach, transoral approach shortened hospitalization time and improved cosmetic appearance. Benign parapharyngeal space tumours not involving critical structures from the parapharyngeal space can be completely resected by an endoscopic-assisted transoral approach with good functional and cosmetic outcome.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Endoscopic-assisted Transoral Approach to Parapharyngeal Space Tumours
    AU  - Ștefan Iemima
    AU  - Tonu Angela
    AU  - Ghiță Dragoș
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    JF  - Advances in Surgical Sciences
    JO  - Advances in Surgical Sciences
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.ass.20200801.12
    AB  - Parapharyngeal space tumours are rare, mostly benign and present few symptoms, being difficult to diagnose it early. CT scan and MR are necessary for topographical diagnosis. Surgical resection is the best possible treatment option, but the approach remains a challenge, as there are several vital elements contained in the parapharyngeal space and, thus, adequate visualization is needed. Different surgical approaches have been described: transcervical-submandibular, transparotid, transmandibular, transoral and combined approaches. Transoral approach is the most controversial one due to cited limited exposure, which can lead to neurovascular injury or incomplete removal of the lesion. It is seldom performed and only for small, extra-parotid and non-vascular tumours of the parapharyngeal space. Wide access to endoscopic equipment in our institute allowed us to perform medium to large benign parapharyngeal tumour resection usig the transoral approach. The use of endoscopic assistance for transoral approach provided direct and magnified visualization of the parapharyngeal space, reducing tissue damage, ensuring adequate hemostasis (which lead to less amount of bleeding) and also confirming complete resection prior to closure. In addition, compared to transcervical approach, transoral approach shortened hospitalization time and improved cosmetic appearance. Benign parapharyngeal space tumours not involving critical structures from the parapharyngeal space can be completely resected by an endoscopic-assisted transoral approach with good functional and cosmetic outcome.
    VL  - 8
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