Massive deep lobe parotid neoplasms and parapharyngeal space-occupying lesions: contemporary diagnostics and surgical...

Regional anatomical peculiarity and the evident increasing incidence of parapharyngeal space neoplasms, have established the necessity of an adequate diagnostic approach for their verification and competent preoperative assessment. Tumours of the parapharyngeal space encompass a wide variety of benign or malignant neoplasms of different origins. The clinical course of 26 patients with parapharyngeal space neoplasms was analysed. A standard diagnostic algorithm for parotid neoplasms was performed, followed by adequate surgical procedure with modifications. Arteriography was used only when CT or MRI suggested a glomous tumor, or possible involvement of the carotid artery, or when those tumours put the carotid artery at risk of surgical injury. The results found from statistical evaluation revealed a higher significance of CT and MRI for tumor extension, localization and comprehension. MRI was dominant for determining tumor character and facial nerve involvement. A transparotideal approach including two modifications was confirmed as being the most effective. When a parapharyngeal tumor is detected deep lobe parotid neoplasms are frequently to be expected. Exact preoperative planning with imaging techniques and a posterolateral parotidectomy approach with an angular mandibular osteotomy produces much better postoperative results in the surgery of deep lobe parotid tumours.