ASO Author Reflections: What is the Best Surgical Approach for Benign Tumors Arising from the Prestyloid Compartment in
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: What is the Best Surgical Approach for Benign Tumors Arising from the Prestyloid Compartment in the Parapharyngeal Space? Takashi Matsuki, MD, PhD1,2 1
Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan; 2Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
PAST Tumors arising in the parapharyngeal space (PPS) are rare, accounting for 0.5% of all head and neck neoplasms.1,2 The PPS can be divided into prestyloid and retrostyloid compartments. The majority of masses arising from the prestyloid and retrostyloid compartments have been reported to be salivary gland tumors and neurogenic tumors, respectively.1,2 Although immediate surgery is not recommended for asymptomatic retrostyloid compartment tumors often found incidentally,1 surgery is recommended for prestyloid compartment tumors because they are usually pleomorphic adenomas, which have the potential for malignant transformation. There are sparse reports on the details of the surgery, including the surgical approach, for prestyloid compartment masses. PRESENT According to a recent clinical review,3 the vast majority of benign tumors of the prestyloid space, regardless of the degree of superior extension, can be resected through a cervical, parotid, or a combined cervical–parotid approach.1 An isolated parotid approach or parotid–cervical approach, which exposes the facial nerve, is recommended for lesions involving the deep lobe of the
Ó Society of Surgical Oncology 2020 First Received: 16 October 2020 Accepted: 16 October 2020 T. Matsuki, MD, PhD e-mail: [email protected]
parotid gland, as it permits the identification and preservation of the facial nerve.1 However, these approaches require a prolonged operative time of 3–5 h. In our study, most tumors (94.0%) of the prestyloid space, including dumbbell-shaped tumors, were removed via a cervical approach alone. The approach requires a shorter operative time of 1–2 h and is associated with few permanent sequelae.4 FUTURE The transoral approach, including endoscopic and robotic surgeries, is minimally invasive, and has become of increasing interest.5 This route, and its indications, will likely become standardized and performed widely. However, the need for an external incision, such as the cervical approach, will remain for lesions unsuitable for transoral surgery because of size, location, histopathological type, or risk of hemorrhage. It is necessary to select an appropriate approach based on the characteristics of each lesion. DISCLOSURES disclose.
Takashi Matsuki has no conflicts of interest to
REFERENCES 1. Lopez F, Suarez C, Vander Poorten V, et al. Contemporary management of primary parapharyngeal space tumors. Head Neck. 2019;41(2): 522–35. 2. Matsuki T, Miura K, Tada Y, et al. Classification of tumors by imaging diagnosis and preoperative fine-needle aspiration cytology in 120 patients with tumors in the
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