[Evaluation and surgical approaches to tumors of the parapharyngeal space]

Tumors of the parapharyngeal space encompass a wide variety of benign or malignant neoplasms. The purpose of this study was to evaluate our experience with the history, diagnosis and management of parapharyngeal tumors.

In a retrospective study the data of 19 patients who underwent surgical excision between 1995 and 2001 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique and surgical approach. 12 patients were female, 7 male. The youngest patient was 17, the oldest 72 years of age (mean: 47).

Two thirds of the resected tumors were benign. Eight tumors originated from salivary glands, neurogenic tumors were found in 6 patients, malignant lymphomas in two cases. CT was performed in 16 patients, an additional MRI was indicated in 5 patients due to the superior soft-tissue resolution. In one patient arteriography revealed a paraganglioma. Preoperative localization of the tumor was possible in all cases. The transcervical approach was performed in the majority of cases (7). An intraoral excision (4) in combination with a transcervical approach (3), transcervical-tarnsmandibular (1) or a midfacial degloving (2) was performed less frequently.

Benign parapharyngeal tumors prevail. In the majority of cases they originate from the salivary glands. CT and MRI are the diagnostic procedure of choice to select the surgical approach with the least morbidity. MRI should be preferred since it provides superior soft-tissue resolution, multiplanar imaging, identification of the vascular structures and no exposition to ionizing radiation. Arteriography should be performed if indicated by MRI findings. Incisional biopsy or fine needle biopsy should be performed only in cases which appear to be unresectable. Intraoral excisions should be indicated only for small tumors. The majority of tumors can be excised using the transcervical approach. Excessive tumor growth or tumors growing close to the skull base may indicate an infratemporal approach or a mandibulotomy.