A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space

  • Shayanne A. LajudEmail author
  • Jaime A. Aponte-Ortiz
  • Miguel Garraton
  • Laureano Giraldez
Case Report


Medullary thyroid cancer (MTC) represents less than 1% of all thyroid cancers. Complete surgical resection remains the mainstay of treatment for locoregional disease. Unfortunately, patients with recurrence may present with metastasis to challenging anatomic locations. We describe the first case of a recurrent MTC metastatic to the parapharyngeal space (PPS) that was managed using a combined transoral robotic surgery (TORS) and transcervical (TC) approach. We review the presentation, natural history, diagnosis and management of recurrent MTC, and describe a novel combined TORS–TC surgical approach for the treatment of PPS metastasis. A 66-year-old male with history of MTC treated with total thyroidectomy in 2000 and a liver resection in 2011 for metastatic MTC was referred to our Head and Neck Surgery Clinic in October 2016 due to increased calcitonin and CEA levels. Exam was significant for mild right tonsillar/pharyngeal bulging and induration. Imaging with PET–CT and MRI showed an enlarging ovoid mass centered within the right PPS without the presence of another systemic metastasis. FNA was consistent with MTC. The patient was taken to the operating room for a combined TORS–TC approach. Final pathology was consistent with metastatic MTC. Until recently, PPS tumors have been managed using highly morbid and cosmetically disfiguring open surgical approach. TORS provides a safe and effective alternative.


Medullary thyroid carcinoma Transoral robotic surgery Parapharyngeal space Transcervical approach Transoral approach TORS 



We would like to thank Amarilys Irizarry Hernandez, Graphic Designer, Information and Technology Center, University of Puerto Rico School of Medicine, for the illustration of the transoral robotic surgical approach to the parapharyngeal space.

Compliance with ethical standards

Conflict of interest

The authors of this manuscript: Shayanne A. Lajud, Jaime A. Aponte-Ortiz, Miguel Garraton, and Laureano Giraldez, have no financial conflicts of interest and nothing to disclose.

Ethical approval

Consent section: The procedure performed was in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from the patient included in the study and additional written informed consent was obtained from the patient for publication of this case report and the accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Otolaryngology Head and Neck Surgery DepartmentUniversity of Puerto Rico School of MedicineSan JuanPuerto Rico

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