Tumors of parapharyngeal space iowa head and neck protocols. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of. Bs buccal space, ica internal carotid artery, ijv internal jugular vein, ms masticator space, pms pharyngeal mucosal space, pps parapharyngeal space, ps parotid space, pvs prevertebral space, rps retropharyngeal space, sms submandibular space, t torus tubarius. Parapharyngeal space tumors is the property of its rightful owner. Surgical approach to parapharyngeal tumours our experience. Surgical anatomy of the parapharyngeal space wiley online library. Retropharyngeal space entire length of neck boundaries.
Trismus, drooling, dysphagia, and odynophagia also are. Anatomy and common pathology of the parapharyngeal space. Complete excision of the tumor is recommended to corroborate the diagnosis suggested by the clinical examination and imaging and, in most cases, as final treatment. Any information contained in this pdf file is automatically generated from. The mainstay of treatment of tumors of the parapharyngeal space is surgical extirpation. We aim to describe the topographical anatomy of the parapharyngeal space to facilitate safe operating in this area.
Surgical approaches to the parapharyngeal space sciencedirect. The majority of the salivary gland tumors were located in the prestyloid space, whereas all neurogenic tumor cases were poststyloid. They are normally confined to treatment within a tertiary referral center due to their histological diversity and complex surrounding anatomy. The parapharyngeal space may be divided into two compartments. To describe the imaging features of a variety of disease processes that may occur in the pps. Anatomy and surgical approaches to the parapharyngeal space. Zygomatictransmandibular approach for giant tumors of the. Management of parapharyngeal tumors is challenging due to the complex anatomic nature of the space and the wide range of pathologies encountered.
Infratemporal fossa, masticator space and parapharyngeal. Its borders include the nasopharynx and oropharynx medially, the masticator space anterolaterally, the deep lobe of the parotid gland posterolaterally, and the retropharyngeal space posteromedially fig. Parapharyngeal space tumors are rare and account for 0. Anterior border pharynx and esophagus buccopharyngeal fascia posterior border alar layer of deep fascia superior border skull base inferior border superior mediastinum combines with buccopharyngeal fascia at level of t1t2.
Transcervical excision of parapharyngeal and retropharyngeal lymph nodes requires a thorough understanding of the anatomy of the neck and parapharyngeal space, along with a stepwise surgical technique to safely expose the parapharyngeal space. Evaluation of the results of surgical treatment of pps tumors in the department of. Anatomy of the parapharyngeal space potential space inverted pyramid with floor at skull base, tip at hyoid, and bounded by the pharyngeal wall medially and the mandible2012 laterally 4. Management of tumors of the parapharyngeal space cancer network. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. Fifteen formalinfixed cadaveric head and neck specimens were dissected on both sides with a surgical microscope. Introduction the complex anatomy of the parapharyngeal space, the surrounding vital structures and late presentation of the tumours affecting this space pose difficult surgical challenge to every. Parapharyngeal space an overview sciencedirect topics. Surgical approaches to the parapharyngeal space eyal raveh, md, karl segal, md, moshe chaimoff, md, raphael feinmesser, md salivary gland tumors are the most common primary lesions that occur in the parapharyngeal space. Parapharyngeal space tumors a surgical challenge raj nagarkar 1, sirshendu roy, ashvin wagh 2 and gauri kokane 1department of surgical oncology, hcg manavata cancer centre, india 2department of head and neck surgical oncology, hcg manavata cancer centre, india submission. Parapharyngeal abscesses the journal of laryngology. Anatomy of the parapharyngeal space potential space inverted pyramid with floor at skull base, tip at hyoid, and bounded by the pharyngeal wall medially and the mandible2012 laterally. Management of deep neck space infections of the parapharyngeal and rpss are part of the otolaryngologists surgical practice.
Any information contained in this pdf file is automatically generated from digital material. Medially, the pps is in close contact with the pharyn geal mucosal space. Trismus, drooling, dysphagia, and odynophagia also are observed commonly. Jul 04, 2016 1 narayana hridayalaya multispeciality, bangalore, india surgical anatomy and pathology the parapharyngeal space is an imaginary space situated lateral to the pharyngeal tube containing vital neurovascular bundles. Transoral surgical anatomy and clinical considerations of. Excision of tumors in the parapharyngeal space using an. The parapharyngeal space pps is a potential space between the skull base above and the hyoid bone below.
Menachem gross, ron eliashar, in orofacial pain and headache, 2008. Preoperative ct or mri imaging was used to evaluate the location of each tumor. The international federation of head and neck oncologic societiescurrent concepts in head and neck surgery and oncology 2012 parapharyngeal space tumors jatin p. A total of 9 salivary gland tumors were located in the prestyloid space and 3 cases were located in the pre and poststyloid spaces. Ppt parapharyngeal space tumors powerpoint presentation. Surgical approaches to the parapharyngeal and retropharyngeal space include transoral and transcervical. Approximately 70% to 80% of tumors originating from the pps are benign. Salivary gland neoplasms benign to malignant ratio 3. The styloid process divides the pps into an anterior or prestyloid compartment and a neurovascular or post. Deep neckspaces anatomy and infections drahmed bahnassyassistant professor of radiology qassim university 2. This study was performed to describe key anatomic landmarks and surgical considerations of transoral robotic resection of the lateral oropharyngeal wall, the parapharyngeal space, and the base of the tongue. May 31, 2011 minimally invasive surgery for parapharyngeal tumor no complication after surgery applicable for geriatric patients tumor less than 7 cm can be extirpated by this approach key point of this. A stepbystep logical approach with surgical considerations. Approaches to the parapharyngeal space plastic surgery key.
Parapharyngeal space mass laryngology jama otolaryngology. What is the anatomy of the parapharyngeal space relevant. Lateral skull base approaches in the management of benign parapharyngeal space tumors. Contemporary management of parapharyngeal tumors springerlink. Part 1, techniques and normal agerelated appearances.
To illustrate the radiological anatomy of the parapharyngeal space pps. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. Tumors of the parapharyngeal space jama otolaryngology. Understanding surgical anatomy will lead to delectated surgical dissection. Parapharyngeal space anatomy cummings refers to the pps also as the lateral pharyngeal or pharyngomaxillary space. It consists largely of fat, neurovascular structures, and, in some definitions, the retromandibular part of the deep lobe of the parotid gland. The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig. Endonasal endoscopic transpterygoid approach to the upper. Knowledge of the surgical anatomy and the landmarks to find the facial nerve are the key to preserving facial nerve function. The lesion caused loss of the fat plane between the parapharyngeal space and masticator space with subsequent inflammation of the pterygoid space. Parapharyngeal space definition of parapharyngeal space by. Tumors of the parapharyngeal space jama otolaryngologyhead.
The parapharyngeal space ie, lateral pharyngeal space, pharyngomaxillary space, pterygomaxillary space, pterygopharyngeal space occupies an inverted pyramidal area bounded by multiple components of the fascial system. We retrospectively studied tumors of the parapharyngeal space treated at the baylor college of medicine affiliated hospital system, houston, from 1972 to 1985. Surgical management of parapharyngeal space tumors. Sep 28, 2016 the parapharyngeal space pps is a potential space between the skull base above and the hyoid bone below. Understanding the anatomy and propagation of infections in the neck, in conjunction with judicious interpretation of imaging, factors into formulating a safe and successful. It consists largely of fat, neurovascular structures, and, in some definitions, the. Imaging of parapharyngeal space lesions focus on the prestyloid compartment ji hoon shin 1, ho kyu lee 1, sang yoon kim 2, choong gon choi 1 and dae chul suh 1. The pharyngeal mucosa of the left lateral pharyngeal wall was effaced owing to mass effect figure, a. Academic anatomy laboratory and tertiary academic hospital. Abstract background several surgical approaches to the parapharyngeal space pps have been proposed. Ct scanning and mri investigations is complimentary and both studies shouldbe performed for evaluation of lesions in this area. Parapharyngeal space pps is the anatomical area lateral to the upper pharynx and. Pdf surgical approaches to the parapharyngeal space.
An objective description of advantages and limitations of the surgical routes is lacking. A rare case of large schwannoma of the parapharyngeal space. The aim of this study was to illustrate the endoscopic surgical anatomy of the infratemporal fossa itf and upper parapharyngeal space and to provide useful landmarks by comparing transnasal. Most parapharyngeal space masses benign, removed through.
Pdf surgical treatment results of parapharyngeal space tumors. Pdf surgical approach to parapharyngeal tumours our. A 47yearold female presented with a 2 cm conventional papillary thyroid cancer in the right thyroid lobe with central right lateral neck metastases, as well as a 2. The masseteric space immediately anterior to the parapharyngeal space. This fascial plane is used as a surgical landmark with the major vessels and cranial nerve. Anatomical complexity and etiology med j malaysia vol 62 no 5 december 2007 415 medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. These lesions could be classified as being either hypervascular glomus tumors or metastatic kidney, thyroid, or venous hemangiomas or hypovascular salivary gland tumors, neurogenic tumors, lymphomas, sarcomas.
The styloid process divides the pps into an anterior or prestyloid compartment and a neurovascular or poststyloid compartment. Masses of the parapharyngeal space are most commonly benign 80%. This chapter presents the relevant surgical anatomy and surgical approaches to the different fascial spaces of the head and neck. The pterygoid muscles arrow were dissected and the parapharyngeal space asterisk was dissected and identified. Ct and mri 7,2cm parapharyngeal space tumor on the left, prestyloid, occluding 70% of pharynx suggestive of pleomorphic adenoma.
Minimally invasive surgery for parapharyngeal tumor no complication after surgery applicable for geriatric patients tumor less than 7 cm can be extirpated by this approach key point of. Oct 09, 2012 outline anatomy pathology clinical evaluation imaging with ct, mri, angiography2012 surgical treatment 3. Parapharyngeal space lesions hong kong journal of radiology. Background the pps is defined as the deepest space in the neck and it consists of the pre. So far, cumulative literature on this topic is limited to singlecenter case reports or case series. The pps is an inverted pyramid with its base against the skull base and its apex. The special traits of the presented case included the following. These lesions could be classified as being either hyper. Tumors of parapharyngeal space are uncommon,comprising of less than 1% of all head and neck neoplasms. It is classed as one of the suprahyoid fascial spaces because it is situated on the lateral aspect of the pharynx and is continuous with the retropharyngeal space posteriorly and the submandibular space anteriorly.
Missing site or subsites will comprimse the function leading to aspiration, dysphagia, speech impairment. Parapharyngeal dissection for papillary thyroid cancer. Surgical approaches the three patients with malignant tumors and surgical excisions received postoperative adjuvant therapy radiation or chemoradiation therapy, table 2. Introduction the complex anatomy of the parapharyngeal space, the surrounding vital structures and late presentation of the tumours affecting this space pose difficult surgical challenge to every otolaryngologist. It consists largely of fat, neurovascular structures, and, in. Outline anatomy pathology clinical evaluation imaging with ct, mri, angiography2012 surgical treatment. Complete surgical excision is the mainstay of treatment. Access to parapharyngeal space vula university of cape town. Fliss, md, telaviv and beersheva, israel objective.
The submandibular space the parapharyngeal space the retropharyngeal space. Multiperspective, quantificationbased study background several surgical approaches to the. Deep neck spaces anatomy of the cervical fascia anatomy of the deep neck spaces relevance to neck infections 3. To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. This fascial space is also known as the lateral pharyngeal space. Surgical anatomy of the parapharyngeal space researchgate.
Mar 18, 2019 transcervical excision of parapharyngeal and retropharyngeal lymph nodes requires a thorough understanding of the anatomy of the neck and parapharyngeal space, along with a stepwise surgical technique to safely expose the parapharyngeal space. Ms is a fascial lined space containing all four masticator muscles, the posterior body and ramus of mandible and the mandibular nerve. This article provides a detailed description of the infratemporal fossa and parapharyngeal space anatomy in cadaveric specimens and offers a neurosurgical perspective on a surgical approach that allows wide exposure and complete resection of giant tumors in this location. It is an inverse triangle where the base is formed by base of skull, while apex is formed by hyoid bone. Dec 28, 2018 background several surgical approaches to the parapharyngeal space pps have been proposed. Background several surgical approaches to the parapharyngeal space pps have been proposed. The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. The study gives an overview of the experience in managing parapharyngeal tumours in a tertiary care setting. Request pdf surgical anatomy of the parapharyngeal space.
Pdf transoral endoscopic anatomy of the parapharyngeal. Anatomy and common pathology of the parapharyngeal space epos. Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. Tumors in the parapharyngeal space pps are uncommon, 1 4 accounting for only 0. The current accepted approach to most deeplobe tumors is the transparotid. With the emergence of transoral robotic approaches, head and neck surgeons are faced with an unfamiliar insideout head and neck anatomy. Sep 05, 2019 prasad sc, piccirillo e, chovanec m, et al. Transoral endoscopic anatomy of the parapharyngeal space.
Nov 14, 2019 management of parapharyngeal tumors is challenging due to the complex anatomic nature of the space and the wide range of pathologies encountered. Female, 69, long time dysphagia, left oropharyngeal swelling. The purpose of this article is to describe the diagnostic evaluation and surgical. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. Management of parapharyngeal and retropharyngeal space. Two surgical procedures have been used by the author to treat 44 tumors in the parapharyngeal space. This fascial plane is used as a surgical landmark with the major vessels and cranial nerve laying deep to it.
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