Journal of Shandong University (Health Sciences) ›› 2020, Vol. 58 ›› Issue (12): 72-76.doi: 10.6040/j.issn.1671-7554.0.2020.0838

Previous Articles     Next Articles

Modified cervical-parotid approach in the resection of upper benign tumors in the parapharyngeal space

WU Hao1, XU Ke2, HAN Liang3, XU Feifei1, WANG Dongqin1, DA Peng1, YIN Yong1   

  1. 1. Department of Otolaryngology Head Neck Surgery, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China;
    2. Department of Stomatology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China;
    3. Department of Head Neck Surgery, Nantong Tumor Hospital, Nantong 226001, Jiangsu, China
  • Published:2020-12-08

PDF (PC)

174

Abstract: Objective To investigate the efficacy of modified cervical-parotid approach in resection of upper benign tumors in the parapharyngeal space. Methods A total of 7 patients were enrolled. Preoperative imaging showed big-sized, dumbbell-shaped tumors with unclear boundary. The modified cervical-parotid approach was adopted. After the main trunk and temporal branch of the facial nerves were identified, the upper part of the tumors was separated through the anterior cartilage of the external auditory canal, the posterior margin of parotid gland and the upper part of temporal branch. The tumors were then isolated and removed from the submaxillary region. During the procedure, the superficial lobe of the parotid gland was preserved, and only the necessary facial nerve branches were dissected. Results All tumors were completely removed in one stage operation. Postoperative pathology showed pleomorphic adenoma in 6 cases and schwannoma in 1 case. The hemorrhage volume was less than 300 mL. Mild peripheral facial paralysis occurred in 1 patient, who returned normal 14 days later. All patients had satisfactory cosmetic outcomes. Conclusion The modified cervical-parotid approach can remove the tumors safely and completely, reduce the exposure of facial nerves and superficial lobe of the parotid gland, and reduce the incidence of postoperative neuropathic complications and parotid pitting changes.

Key words: Parapharyngeal space, Tumor, Benign, Surgery, Surgical approach

CLC Number: 

  • R766
[1] Kuet ML, Kasbekar AV, Masterson L, et al. Management of tumors arising from the parapharyngeal space: a systematic review of 1, 293 cases reported over 25 years [J]. Laryngoscope, 2015, 125(6): 1372-1381.
[2] Stanley RE. Parapharyngeal space tumours [J]. Ann Acad Med Singapore, 1991, 20(5): 589-596.
[3] Kanzaki S, Nameki H. Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images [J]. J Laryngol Otol, 2008, 122(6): 628-634.
[4] 文锋, 沈泓, 高为华, 等. 72例咽旁间隙肿瘤患者的诊疗分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(17): 1343-1347. WEN Feng, SHEN Hong, GAO Weihua, et al. Analysis and surgical treatment of 72 cases of parapharyngeal space tumors [J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(17): 1343-1347.
[5] Wang XL, Xu ZG, Wu YH, et al. Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patient s[J]. Chin Med J(Engl), 2012, 125(20): 3635-3639.
[6] Singh M, Gupta SC, Singla A. Our experiences with parapharyngeal space tumors and systematic review of the literature [J]. Indian J Otolaryngol Head Neck Surg, 2009, 61(2): 112-119.
[7] Batsakis JG, Sneige N. Parapharyngeal and retropharyngeal space diseases [J]. Ann Otol Rhinol Laryngol, 1989, 98(4 pt 1): 320-321.
[8] Shi XL, Tao L, Li XM, et al. Surgical management of primary parapharyngeal space tumors: a 10-year review [J]. Acta Oto-Laryngol, 2017, 137(6): 656-661.
[9] Riffat F, Dwivedi RC, Palme C, et al. A systematic review of 1143 parapharyngeal space tumors reported over 20 years [J]. Oral Oncol, 2014, 50(5): 421-430.
[10] Som PM, Curtin HD. Lesions of the parapharyngeal space. Role of MR imaging [J]. Otolaryngol Clin N Am, 1995, 28(3): 515.
[11] Hong Y, Hu J, Liang Z. Analysis of clinical diagnosis and treatment of 112 cases of parapharyngeal space tumors [J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015, 29(11): 994-997.
[12] Gupta A, Chazen JL, Phillips CD. Imaging evaluation of the parapharyngeal space [J]. Otolaryngol Clin North Am, 2012, 45(6): 1223-1232.
[13] Najeeb T, Khan M. Sympathetic chain schwannoma resembling carotid body tumour [J]. J Coll Physicians Surg Pak, 2016, 26(6 suppl): 68-70.
[14] Chen WL, Wang WJ, Huang ZQ, et al. Osteotomy in the vertical ramus outside the mandibular foramen for tumours in the parapharyngeal space [J]. J Craniomaxillofac Surg, 2014, 42(3): 29-32.
[15] 王晓敏, 李慧, 陈德尚, 等. 高位咽旁间隙良性肿瘤的手术治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(23): 1804-1809. WANG Xiaomin, LI Hui, CHEN Deshang, et al. The surgical management of upper parapharyngeal regions [J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(23): 1804-1809.
[16] 黄乃邦, 达鹏, 卢军, 等. 不同下颌骨截骨方式在咽相关区域肿瘤手术中的应用[J]. 山东大学学报(医学版), 2015, 53(8): 79-82. HUANG Naibang, DA Peng, LU Jun, et al. Applications of different mandibulotomy approaches to the resection of pharyngeal region tumors [J]. Journal of Shandong University(Health Sciences), 2015, 53(8): 79-82.
[17] Ducic Y, Oxford L, Pontius AT. Transoral approach to the superomedial parapharyngeal space [J]. Otolaryngol Head Neck Surg, 2006, 134(3): 466-470.
[18] Dimitrijevic MV, Jesic SD, Mikic AA, et al. Parapharyngeal space tumors: 61 case reviews [J]. Int J Oral Maxillofac Surg, 2010, 39(10): 983-989.
[19] Cassoni A, Terenzi V, Della Monaca M, et al. Parapharyngeal space benign tumours: our experience [J]. J Craniomaxillofac Surg, 2014, 42(2): 101-105.
[20] Papadogeorgakis N, Petsinis V, Goutzanis L, et al. Parapharyngeal space tumors: surgical approaches in a series of 13 cases [J]. Int J Oral Maxillofac Surg, 2010, 39(3): 243-250.
[21] Betka J, Chovanec M, Klozar J, et al. Transoral and combined transoral-transcervical approach in the surgery of parapharyngeal tumors [J]. Eur Arch Otorhinolaryngol, 2010, 267(5): 765-772.
[22] 黄卓珊, 张大明, 陈伟良, 等. 2种手术入路在巨大咽旁间隙肿瘤切除术中的效果比较[J]. 中国口腔颌面外科杂志, 2018, 16(1): 56-59. HUANG Zhuoshan, ZHANG Daming, CHEN Weiliang, et al. Endoscopy-assisted transoral versus endoscopy-assisted transcervical minimal incision plus mandibular osteotomy approach in resection of large parapharyngeal space tumors [J]. China Journal of Oral and Maxillofacial Surgery, 2018, 16(1): 56-59.
[23] Liu Y, Yu HJ, Zhen HT. Transoral and endoscope-assisted transoral approaches to resecting benign tumours of the parapharyngeal space located in the medial portion of the carotid sheaths and extending toward the skull base: our experience [J]. J Laryngol Otol, 2018, 132(8): 748-752.
[24] Okamoto I, Tsukahara K, Sato H. Parapharyngeal space tumor surgery using a modified cervical-parotid approach [J]. Acta Oto-Laryngol, 2018, 138(2): 165-169.
[25] 刘丰, 俞志维, 刘胜文, 等. 咽旁间隙肿瘤手术入路10例分析[J]. 口腔颌面外科杂志, 2015, 25(3): 216-219. LIU Feng, YU Zhiwei, LIU Shengwen, et al. Surgical approaches of parapharyngeal space tumors: report of 10 cases [J]. Journal of Oral and Maxillofacial Surgery, 2015, 25(3): 216-219.
[1] WANG Wei, WANG Yi-Feng, ZHANG Ling-Mei, LIN Qiong-Yan, HUANG Ju. umorigenicity and invasion of side population in human ovarian epithelial cancer OVCAR3 cells [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2209, 47(6): 8-11.
[2] LI Bo-Bo, LI Dao-Tang, LIU Shu-Guang, WANG Xing-Wu. Expression of serum DKK-1 in esophageal cancer [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2209, 47(6): 58-61.
[3] GAO Pei, MAO Changlin, CHEN Feng, HE Wei, GUAN Yong,LYU Jiaju, LI Shanjun, DING Sentai. Application of CT three-dimensional reconstruction modified R.E.N.A.L. score in 50 cases of laparoscopic partial nephrectomy [J]. Journal of Shandong University (Health Sciences), 2020, 1(9): 52-57.
[4] Ju LIU,Qiang WU,Luyue YU,Fengming LIN. Brain tumor image segmentation based on deep learning techniques [J]. Journal of Shandong University (Health Sciences), 2020, 1(8): 42-49, 73.
[5] Jizong ZHAO. Neurosurgery plays a key role in brain science research [J]. Journal of Shandong University (Health Sciences), 2020, 1(8): 1-4.
[6] Jian WANG,Wenjing ZHOU,Zhiyi XUE,Xiaofei LIU. Overview of glioblastoma models and development and application of brain organoids [J]. Journal of Shandong University (Health Sciences), 2020, 1(8): 74-80.
[7] GUO Zhihua, ZHAO Daqing, XING Yuan, WANG Wei, LIANG Leping, YANG Jing, ZHAO Qianqian. Single-stage end-to-end anastomosis in the management of severe cervical tracheal stenosis [J]. Journal of Shandong University (Health Sciences), 2020, 1(7): 72-76.
[8] MA Weijiang,WANG Gaojun,OUYANG Xun,ZANG Chenxi,LIU Xin. Effect of non-intubated spontaneous ventilation anesthesia used in video-assisted thoracoscopic surgery: a Meta-analysis [J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 29-37.
[9] LIU Yuanyuan, WANG Pei, CHU Haichen. Effects of different anesthesia depths on the cerebral oxygen metabolism indexes in 150 patients undergoing brain surgery [J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 65-71.
[10] WANG Bo, XIONG Ying, NI Zhifu, QU Zhenfan. Application of ERAS in day hernia surgery for children aged 1 to 3 years [J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 92-96.
[11] ZHI Mengwei, JIANG Zhiwei, DAI Xinjuan, WANG Gang, CHENG Wei. Clinical observation of heart rate variability in patients with gastric cancer during perioperative period under the guidance of enhanced recovery after surgery [J]. Journal of Shandong University (Health Sciences), 2020, 58(11): 85-91.
[12] LI Yujie, HAN Wei, HUANG Wei, DONG Yuke, LI Tao, DANG Yanwei, CAI Xiaoqing, SHEN Xiao, GONG Wendan, XU Lianfang. Application of enhanced recovery after surgery in 44 cases of uvulopalatopharyngoplasty [J]. Journal of Shandong University (Health Sciences), 2020, 58(11): 92-97.
[13] FENG Zhiyu, YANG Yanliang, GUO Rui, XU Huihui, ZHANG Jian, GUO Kai, WANG Guangzhen, WANG Hui. Diagnosis and surgical treatment of pulmonary artery sling complicated with tracheal stenosis [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 48-51.
[14] WANG Yuhong, ZHANG Lihong, WANG Linsheng, CHEN Yueqin, WANG Yanhui, WANG Jiehuan, LI Chuanfu. Imaging features of granular cell tumor in the alimentary system [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 66-70.
[15] HAN Fuyan, CHENG Shiqing, WANG Zhaobao, JU Ying. Clinical significance of preoperative red blood cell distribution width in peripheral blood of patients with esophageal cancer [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 67-72.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd