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Objective Using three-dimensional reconstruction techniques to facilitate precision surgery of parapharyngeal interstitial tumours with transoral endoscopic assistance. Methods We reported three cases in this article including a hemangioma in the left parapharyngeal space, a nerve sheath tumour in the right parapharyngeal space and a pleomorphic adenoma in the left parapharyngeal space. Three-dimensional (3D) visualisation technology facilitated the creation of a digital three-dimensional model of the patient's tumour and the surrounding structures. This model enabled intuitive visualisation of the tumour's anatomical characteristics and anatomical relationship with surrounding tissues. Consequently, general anaesthesia was administered with the assistance of transoral endoscopy, and the surgical incision was strategically located in the lateral palatoglossal arch and the pharyngo-palatine muscular space. Results The postoperative pathological diagnosis was as follows: left parapharyngeal hemangioma, right parapharyngeal complex nerve sheath tumour and left parapharyngeal pleomorphic adenoma. Following the administration of oral endoscopy-assisted surgical treatment, the patient exhibited a marked alleviation of related symptoms. No complications were observed. Discussion The integration of medical imaging with contemporary software for three-dimensional reconstruction facilitates the delivery of precise and minimally invasive treatment, ensuring enhanced safety and efficacy. Transoral endoscopic-assisted parapharyngeal space tumour resection is a surgical procedure that offers several advantages, including minimal trauma, rapid recovery and a low complication rate. It is considered a highly effective method for treating benign tumours in the parapharyngeal space. Implications for practice The combination of medical imaging and three-dimensional technology can better evaluate the preoperative location of complex tumors,avoid the risk of intraoperative damage to important structures. And it can also be used in medical teaching.

Purpose The aim of this study is to obtain the anatomical limits of the parapharyngeal space by transoral surgical approach, in order to objectively determine the types of lesions according to location, where this type of approach is more indicated. Methods A prospective, experimental, radio-anatomical study was performed on 10 cryopreserved human heads(20 sides). A transoral approach of the parapharyngeal space was performed determining its anatomical limits by CT navigation. A statistical analysis of the registered variables was carried out. Results Intraoral endoscopic dissection of the parapharyngeal space was possible in all anatomical pieces (10 heads, 20 sides). The surgical technique was started by placing a laryngopharyngoscopic retractor. The scalpel incision was made from the posterior border of the hard palate, extending along the lateral border of the soft palate, following the glossopalatine arch and ending at the base of the tongue, in its posterolateral region. Under direct vision with a 0º rigid endoscope, we proceeded to the dissection by planes, identifying all the relevant vasculonervous, osseous and muscular structures. Once all the anatomical references were located, the planned measurements were taken using the surgical navigator. Conclusions The endoscopic intraoral approach constitutes a feasible, safe and direct access route to the parapharyngeal space. This approach would be especially indicated in lesions of the parapharyngeal space (PPS) that do not exceed the styloid and pterygoid processes cranially, do not have significant retrostylial extension and do not substantially reach the lower area of the PPS.

BackgroundBenefits and drawbacks of robotic surgical approaches for parapharyngeal space (PPS) tumors remain undetermined. The purpose of this study is to compare surgical outcomes of PPS tumor patients who underwent robotic surgery with those of patients who received conventional surgical treatment.Patients and MethodsWe retrospectively analyzed clinicopathologic data from 136 patients who underwent surgical removal of PPS tumors via conventional or robotic approaches.ResultsWe identified PPS tumors in pre- and poststyloid regions in 87 (64%) and 49 (36%) patients, respectively. There were 48 (35.3%) pleomorphic adenomas, 36 (26.5%) schwannomas, and 24 (17.6%) paragangliomas. Conventional surgical techniques were performed in 83 patients, and robotic surgical approaches were administered to 53 patients. Transcervical-parotid and transcervical approaches were most commonly performed in conventional surgery, while transoral and retroauricular approaches were the preferred surgical methods in robotic surgery for pre- and poststyloid PPS tumors, respectively. Robotic surgery resulted in less estimated blood loss during poststyloid PPS tumor surgery. Postoperative cranial nerve complications were noted in 36 of 83 cases (43.4%) in the conventional surgery group and in 17 of 53 cases (32.1%) in the robotic surgery group. Intraoperative tumor spillage of pleomorphic adenoma showed no significant differences between the two groups (13.6% in conventional vs. 15.4% in robotic surgery). The mean follow-up time was 4.9 ± 3.4 years, and recurrences were observed in two patients during follow-up without a significant difference between the two groups (4.5% in conventional vs. 3.8% in robotic surgery).ConclusionsRobotic surgery in PPS tumors is feasible through transoral, retroauricular, or combined approaches and provides treatment outcomes comparable to those of conventional open surgery.

We present a case of a female patient with solitary fibrous tumour (SFT) originating in the parapharyngeal space which was successfully resected using an open transoral approach. The patient presented with a worsening airway obstruction, obstructive sleep apnoea, and dysphagia for three years. Rhinolaryngoscopy revealed a right nasopharynx and oropharynx lateral pharyngeal wall submucosal mass. Histopathological analysis was consistent with an SFT. This uncommon site of a rare tumour often presents diagnostic challenges or leads to overt misdiagnosis. We interrogated the literature in respect of the diagnostic and therapeutic approaches for this rare condition.

Purpose This study aimed to investigate whether multiparametric magnetic resonance imaging (MRI) including dynamic contrast-enhanced (DCE) and diffusion weighted (DW) MRI can differentiate pleomorphic adenoma (PA) from schwannoma in the parapharyngeal space. Methods Forty-six patients with pathologically proven PAs and 47 schwannomas in the parapharyngeal space were enrolled. All patients underwent conventional MRI, and DW-MRI and DCE-MRI were performed in 30 and 33 patients, respectively. Fisher’s exact, Mann-Whitney-U tests and Independent samples t-test were used to compare variables between PAs and schwannomas. Multivariate logistic regression analysis was used to examine the diagnostic performance of MRI parameters. Results The PAs usually show lobulation sign, posterior displacement of ICA and attached to the parotid gland deep leaf, while bird beak configuration, anterior displacement of ICA and involvement of foramen jugular were more commonly seen in the schwannomas(all p  < 0.001). The washout rate of PAs was found to be higher than that of schwannomas ( p  = 0.035), whereas no significance was found in the other DCE-MRI parameters and in ADCs( p  > 0.05). Using a combination of conventional MRI features including lobulation sign, bird beak configuration, direction of internal carotid artery(ICA) displacement and attached to the parotid gland in multivariate logistic regression analysis, sensitivity, specificity, and accuracy in differential diagnosis of PAs and schwannomas were 97.8%, 91.5% and 94.6%, respectively. Conclusion Conventional MRI can effectively differentiate PAs from schwannomas in the parapharyngeal space with a high diagnostic accuracy. The DCE-MRI and DWI have limited added diagnostic value to conventional MRI in the differential diagnosis.

Background Superb knowledge of anatomy and techniques to remove the natural barriers preventing full access to the most lateral aspect of the skull base determines the ease of using the transpterygoid approach (ETPA) as the main gateway for all the coronal planes during endonasal surgeries. Methods Throughout stepwise image-guided cadaveric dissections, we describe the surgical anatomy and nuances of the ETPA to the pterygopalatine fossa (PPF) and upper parapharyngeal space (UPPS). Conclusion The ETPA represents a lateral extension of the midline corridor and provides a valuable route to access the PPF/UPPS. Major landmarks for this EEA are the infraorbital canal, sphenopalatine foramen, and vidian nerve. It comprises the removal of the palatine bone, posterior wall of the maxillary sinus, and PPF transposition to drill the pterygoid process.

The solitary fibrous tumor (SFT) is usually described as a lesion arising from the pleura. Rarely, it has been described in the parapharyngeal space (PS). This study aims to report two cases of SFT in the PS and to perform a literature review on this topic. Two patients undergoing surgical resection of a SFT in the PS, were reported. A literature review on SFT of the PS, was also performed. Two patients were analyzed. Both patients underwent surgical resection, followed by adjuvant radiotherapy, for SFT arising from the PS. The postoperative course was uneventful and both patients recovered well after the procedure. No recurrences were diagnosed during the followup. SFT of the PS is an infrequent entity. Surgical resection is the most used treatment, and adjuvant radiation should be considered in patients with recurrence risk factors or distant metastases.

Background and purpose Parapharyngeal space (PPS) neoplasms represent 1% of all head and neck tumors and are mostly benign. Surgery is the mainstay of treatment and the transcervical–transparotid (TC–TP) corridor still represents the workhorse for adequate PPS exposure. Our series investigates strengths and limits of this approach on a multi-institutional basis. Methods We reviewed consecutive patients submitted to PPS surgery via TC–TP route between 2010 and 2020. Hospital stay, early and long-term complications, and disease status were assessed. Results One hundred and twenty nine patients were enrolled. Most tumors were benign (79.8%) and involved the prestyloid space (83.7%); the median largest diameter was 4.0 cm. The TC–TP corridor was used in 70.5% of patients, while a pure TC route in about a quarter of cases. Early postoperative VII CN palsy was evident in 32.3% of patients, while X CN deficit in 9.4%. The long-term morbidity rate was 34.1%, with persistent CN impairment detectable in 26.4% of patients: carotid space location, lesion diameter and malignant histology were the main independent predictors of morbidity. A recurrence occurred in 12 patients (9.4%). Conclusions The TC–TP corridor represents the benchmark for surgical management of most of PPS neoplasms, though substantial morbidity can still be expected.

We aimed to describe the microbiology of parapharyngeal abscess (PPA) and point out the likely pathogens using the following principles to suggest pathogenic significance: (1) frequent recovery, (2) abundant growth, (3) growth in relative abundance to other microorganisms, (4) percentage of the isolates recovered in both absolute and relative abundance, (5) more frequent recovery in PPA pus compared with tonsillar surface and tissue. Comprehensive bacterial cultures were performed on specimens obtained from adult patients (n = 60) with surgically verified PPA, who were prospectively enrolled at five Danish ear-nose-throat departments. The prevalent isolates (in PPA pus) were unspecified anaerobes (73%), non-hemolytic streptococci (67%), Streptococcus anginosus group (SAG) (40%), Corynebacterium spp. (25%), Neisseria spp. (23%), Fusobacterium spp. (22%), Fusobacterium necrophorum (17%), Prevotella spp. (12%), and Streptococcus pyogenes (10%). The bacteria most frequently isolated in heavy (maximum) growth were unspecified anaerobes (60%), SAG (40%), F. necrophorum (23%), and Prevotella spp. (17%). The predominant microorganisms (those found in highest relative abundance) were unspecified anaerobes (53%), SAG (28%), non-hemolytic streptococci (25%), F. necrophorum (15%), S. pyogenes (10%), and Prevotella spp. (10%). Four potential pathogens were found in both heavy growth and highest relative abundance in at least 50% of cases: F. necrophorum, Prevotella spp., SAG, and S. pyogenes. SAG, Prevotella spp., F. necrophorum, S. pyogenes, and Bacteroides spp. were recovered with the same or higher frequency from PPA pus compared with tonsillar tissue and surface. Our findings suggest that SAG, F. necrophorum, Prevotella, and S. pyogenes are significant pathogens in PPA development.

Cavernous haemangiomas are a very rare occurrence in the parapharyngeal space (PPS). Here, we present a case of a 58-year-old woman with an incidentally identified left PPS mass thought to be a pleomorphic adenoma that underwent excision by transoral robotic surgery (TORS). Intraoperative findings demonstrated no solid mass present and histological assessment of resected tissue confirmed a cavernous haemangioma. We discuss our experience in the management of a radiological and surgical mismatch of a PPS mass in what we believe to be the first cavernous haemangioma to be excised by TORS in this region.