Skip to main content
SpringerLink
Log in

The transcervical–transparotid corridor for management of parapharyngeal space neoplasms: strengths and limits in a bi-institutional retrospective series

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Data available on request due to privacy/ethical restrictions.

References

  1. Olsen KD (1994) Tumors and surgery of the parapharyngeal space. Laryngoscope 104:1–28. https://doi.org/10.1288/00005537-199405000-00001

    Article  CAS  PubMed  Google Scholar 

  2. Stambuk HE, Patel SG (2008) Imaging of the parapharyngeal space. Otolaryngol Clin North Am 41:77–101. https://doi.org/10.1016/j.otc.2007.10.012

    Article  PubMed  Google Scholar 

  3. Riffat F, Dwivedi RC, Palme C et al (2014) A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral Oncol 50:421–430. https://doi.org/10.1016/j.oraloncology.2014.02.007

    Article  PubMed  Google Scholar 

  4. Kuet ML, Kasbekar AV, Masterson L, Jani P (2015) Management of tumors arising from the parapharyngeal space: a systematic review of 1,293 cases reported over 25 years. Laryngoscope 125:1372–1381

    Article  PubMed  Google Scholar 

  5. Shahab R, Heliwell T, Jones AS (2005) How we do it: a series of 114 primary pharyngeal space neoplasms. Clin Otolaryngol 30:364–367. https://doi.org/10.1111/j.1365-2273.2005.00993.x

    Article  CAS  PubMed  Google Scholar 

  6. Carrau RL, Myers EN, Johnson JT (1990) Management of tumors arising in the parapharyngeal space. Laryngoscope 100:583–589. https://doi.org/10.1288/00005537-199006000-00006

    Article  CAS  PubMed  Google Scholar 

  7. Giordano L, Pilolli F, Toma S, Bussi M (2015) Parapharyngeal metastases from thyroid cancer: surgical management of two cases with minimally-invasive video-assisted technique. Acta Otorhinolaryngol Ital 35:289–292

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Pilolli F, Giordano L, Galli A, Bussi M (2016) Parapharyngeal space tumours: video-assisted minimally invasive transcervical approach. Acta Otorhinolaryngol Ital. https://doi.org/10.14639/0392-100X-709

    Article  PubMed  PubMed Central  Google Scholar 

  9. Zhi K, Ren W, Zhou H et al (2009) Management of parapharyngeal-space tumors. J Oral Maxillofac Surg 67:1239–1244. https://doi.org/10.1016/j.joms.2008.09.003

    Article  PubMed  Google Scholar 

  10. Dimitrijevic MV, Jesic SD, Mikic AA et al (2010) Parapharyngeal space tumors: 61 case reviews. Int J Oral Maxillofac Surg 39:983–989. https://doi.org/10.1016/j.ijom.2010.06.005

    Article  CAS  PubMed  Google Scholar 

  11. Vargas N, Assadsangabi R, Birkeland A et al (2022) Pre-styloid parapharyngeal space masses—tumor margins as a predictor of benign versus malignant histology on pre-operative CT or MRI. Neuroradiol J 35:701–705. https://doi.org/10.1177/19714009221089027

    Article  PubMed  PubMed Central  Google Scholar 

  12. Muraz E, Delemazure AS, Mourrain-Langlois E et al (2016) Peripharyngeal space tumors: can magnetic resonance and multidetector-row computed tomography help predict location, malignancy and tumor type? Diagn Interv Imaging 97:617–625. https://doi.org/10.1016/j.diii.2015.09.015

    Article  CAS  PubMed  Google Scholar 

  13. Fermi M, Serafini E, Ferri G et al (2022) Management of parapharyngeal space tumors with transparotid–transcervical approach: analysis of prognostic factors related with disease-control and functional outcomes. Eur Arch Oto-Rhino-Laryngology 279:2631–2639. https://doi.org/10.1007/s00405-021-07074-z

    Article  Google Scholar 

  14. Aghazadeh K, Khorsandi M, Rikhtegar M et al (2020) Surgical approaches to benign parapharyngeal space tumors-5-year experience. Iran J Otorhinolaryngol 32:43–48. https://doi.org/10.22038/ijorl.2019.38350.2268

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ferrari M, Schreiber A, Mattavelli D et al (2019) Surgical anatomy of the parapharyngeal space: multiperspective, quantification-based study. Head Neck 41:642–656. https://doi.org/10.1002/hed.25378

    Article  PubMed  Google Scholar 

  16. van Hees T, van Weert S, Witte B, René Leemans C (2018) Tumors of the parapharyngeal space: the VU University medical center experience over a 20-year period. Eur Arch Oto-Rhino-Laryngology 275:967–972. https://doi.org/10.1007/s00405-018-4891-x

    Article  Google Scholar 

  17. Dallan I, Fiacchini G, Turri-Zanoni M et al (2016) Endoscopic-assisted transoral-transpharyngeal approach to parapharyngeal space and infratemporal fossa: focus on feasibility and lessons learned. Eur Arch Oto-Rhino-Laryngol 273:3965–3972. https://doi.org/10.1007/s00405-016-4074-6

    Article  Google Scholar 

  18. Lombardi D, Ferrari M, Paderno A et al (2020) Selection of the surgical approach for lesions with parapharyngeal space involvement: a single-center experience on 153 cases. Oral Oncol. https://doi.org/10.1016/j.oraloncology.2020.104872

    Article  PubMed  Google Scholar 

  19. Netterville JL, Groom K (2015) Function-sparing intracapsular enucleation of cervical Schwannomas. Curr Opin Otolaryngol Head Neck Surg 23:176–179

    Article  PubMed  Google Scholar 

  20. Sandler ML, Sims JR, Sinclair C et al (2019) Vagal schwannomas of the head and neck: a comprehensive review and a novel approach to preserving vocal cord innervation and function. Head Neck 41:2450–2466

    Article  PubMed  Google Scholar 

  21. Guo Y, Guo C, Zhang L, Yu G (2014) Extracapsular dissection of the parapharyngeal space for a pleomorphic adenoma: a 10-year review. Br J Oral Maxillofac Surg 52:557–562. https://doi.org/10.1016/j.bjoms.2014.02.019

    Article  PubMed  Google Scholar 

  22. Colella G, Cannavale R, Chiodini P (2015) Meta-analysis of surgical approaches to the treatment of parotid pleomorphic adenomas and recurrence rates. J Cranio-Maxillofacial Surg 43:738–745. https://doi.org/10.1016/j.jcms.2015.03.017

    Article  Google Scholar 

  23. Witt RL, Eisele DW, Morton RP et al (2015) Etiology and management of recurrent parotid pleomorphic adenoma. Laryngoscope 125:888–893

    Article  PubMed  Google Scholar 

  24. Chan JYK, Tsang RK, Eisele DW, Richmon JD (2015) Transoral robotic surgery of the parapharyngeal space: a case series and systematic review. Head Neck 37:293–298

    Article  PubMed  Google Scholar 

  25. Galli A, Tulli M, Vella A et al (2021) The importance of the patient’s perspective in function-sparing parotid surgery for benign neoplasms: clinical reappraisal. Acta Otorhinolaryngol Ital 41:410–418. https://doi.org/10.14639/0392-100X-N1463

    Article  PubMed  PubMed Central  Google Scholar 

  26. Grosheva M, Pick C, Granitzka T et al (2019) Impact of extent of parotidectomy on early and long-term complications: a prospective multicenter cohort trial. Head Neck. https://doi.org/10.1002/hed.25651

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy

    Andrea Galli, Leone Giordano, Chiara Bramati & Mario Bussi

  2. Dept. of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Modena, Via del Pozzo, 71, 41125, Modena, Italy

    Francesco Mattioli & Edoardo Serafini

  3. Dept. of Otorhinolaryngology-Head and Neck Surgery, IRCCS Azienda Ospedaliera Universitaria di Bologna, Policlinico Sant’Orsola Malpighi, Via Giuseppe Massarenti, 9, 40138, Bologna, Italy

    Matteo Fermi

Authors
  1. Andrea Galli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leone Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Mattioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edoardo Serafini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matteo Fermi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chiara Bramati
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mario Bussi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AG, ES, CB and MF. The first draft of the manuscript was written by AG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andrea Galli.

Ethics declarations

Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Research involving human participants and/or animals

All performed procedures and data management were in accordance with the ethical standards and the principles stated in the 1964 Declaration of Helsinki and its later amendments. The present protocol was evaluated and approved by Institutional Review Board (CER Emilia Romagna, protocol number: 0026904/21).

Informed consent

Informed consent for data management was obtained for all subjects at the moment of hospital admission for surgery.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Galli, A., Giordano, L., Mattioli, F. et al. The transcervical–transparotid corridor for management of parapharyngeal space neoplasms: strengths and limits in a bi-institutional retrospective series. Eur Arch Otorhinolaryngol 281, 897–906 (2024). https://doi.org/10.1007/s00405-023-08256-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-023-08256-7

Keywords

Search

Navigation