Resection of Parapharyngeal Space Tumors Located in the Prestyloid Compartment: Efficacy of the Cervical Approach
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Resection of Parapharyngeal Space Tumors Located in the Prestyloid Compartment: Efficacy of the Cervical Approach Takashi Matsuki, MD, PhD1,2, Isaku Okamoto, MD, PhD3, Yuichiro Tada, MD, PhD1, Tatsuo Masubuchi, MD, PhD1, Chihiro Fushimi, DDS, PhD1, Shinetsu Kamata, MD, PhD1, Shunsuke Miyamoto, MD, PhD2, Taku Yamashita, MD, PhD2, and Kouki Miura, MD, PhD1 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, Kanagawa , Japan; 3Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University School of Medicine, Tokyo, Japan
ABSTRACT Background. Parapharyngeal space tumors are rare. Among them, tumors in the prestyloid compartment are particularly suitable for surgery; however, there are no detailed reports of such surgery and their features remain unknown. Methods. We conducted a retrospective cohort study. For 67 surgical cases of benign tumors in this compartment, we examined the patient and tumor characteristics, fine-needle aspiration cytology (FNAC), and intraoperative details such as surgical approach, use of complete excision, and postoperative complications. Results. Pleomorphic adenomas (PAs) comprised 73.1% of the lesions. The diagnostic accuracy of FNAC to differentiate benign and malignant tumors was 97.7%. Of the treated lesions, 94.0% were removed via the cervical approach alone, including all PAs. The remaining 6.0% were resected via the cervical–parotid approach. The median operative time and bleeding volume were 89 min and 50 mL, respectively. Operative time using the cervical approach was significantly shorter (p = 0.021). All cases could be treated via complete surgical excision. Postoperative complications occurred in 32.8% of patients, with transient slight facial palsy being the most common. No
Ó Society of Surgical Oncology 2020 First Received: 1 July 2020 Accepted: 8 October 2020 T. Matsuki, MD, PhD e-mail: [email protected]
fatal complications occurred and 92.5% of patients had no sequelae. There was no significant association between complications and surgical approach. Conclusion. Based on diagnosis by FNAC, with a high accuracy rate, most benign prestyloid tumors, especially PAs, were resected using the cervical approach alone, with a shorter operative time and without severe complications.
Tumors arising in the parapharyngeal space (PPS) are rare, accounting for 0.5% of all head and neck neoplasms.1 This space has an inverted pyramid shape, with the base formed by the base of the skull and the apex formed by the greater cornu of the hyoid bone.1,2 The PPS can be divided into the prestyloid and retrostyloid (poststyloid) compartments. The fascia separating the PPS into these compartments extends from the styloid process to the tensor veli palatini muscle.1,3,4 The prestyloid compartment contains the deep lobe of the parotid gland, minor
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