Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Liter
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Different Approaches to the Overlapping Infratemporal Fossa and Parapharyngeal Spaces: a Case Series and Review of Literature Gunjan Dwivedi1 • Vikas Gupta2 • Vibhu Tiwari3 • Uma Patnaik1 Amit Sood1 • Abha Kumari1 • Sanjeeva Bharadwaja3
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Received: 9 August 2020 / Accepted: 21 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Parapharyngeal space and infratemporal fossa are 2 overlapping spaces in head and neck which have complex anatomy with vital neurovascular structures passing through them. Tumors of this region are extremely rare but majority of them (80%) are benign. Benign tumors of this region can lead to swellings in facial region, neck and oropharynx. Dysphagia may be a complaint of the patient. Many of these tumors have malignant potential. Removal of these tumors requires a good understanding of the anatomy of this space so that correct surgical approach can be selected. The surgeon needs to be adept in using the most suitable surgical approach for excision of these tumors. There are various approaches which can be used to access these deeply seated tumors but the issue of prime importance is selecting the appropriate approach for the various tumors here based on their size and their exact location in this complex anatomical space. Inappropriate approach can lead to inadequate tumor excision and can lead to injuries to the neurovascular structures in this region which can cause significant disability. The case series reported here describes the various approaches to this region and highlights the importance of correct selection of the surgical approach. Keywords Parapharyngeal space Infratemporal fossa Transparotid Transcervical Mandibulotomy Maxillary swing
& Gunjan Dwivedi [email protected] 1
Department of ENT, CHSC, AFMC, Pune, India
2
Department of ENT, CHCC, Lucknow, India
3
Resident ENT, AFMC, Pune, India
Introduction The terms ‘Parapharyngeal space’ (PPS) and ‘infratemporal fossa’ (ITF) define 2 intriguing spaces in head and neck which have been used interchangeably at times. Though the 2 spaces have been defined variably in literature with different boundaries they do have overlapping areas. Tumors in these spaces are rare and 80% of these tumors are benign [1, 2]. A sound knowledge of the anatomy of these 2 spaces is of paramount importance in deciding which approach to take while addressing the benign tumors in these spaces without giving significant morbidity. The PPS is an inverted pyramid shaped potential neck space filled with areolar tissue. Its base lies superiorly at the skull base formed by the sphenoid and temporal bones. Its apex lies inferiorly at the greater cornu of the hyoid bone. Jugular fossa, hypoglossal canal and the foramen lacerum lie in its roof. It has 3 sides, medially the superior constrictor muscle, the buccopharyngeal membrane and the pharynx, laterally the medial pterygoid muscle, the ramus of the mandible, and the deep lobe of the parotid gland, and below the level of the mandible, the lateral side has the
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