Recent advances in surgical management of parapharyngeal space tumors

To summarize nuances in the surgical management of parapharyngeal space (PPS) tumors aimed to reduce postoperative sequelae without affecting oncologic outcomes.

The contemporary trend in surgery of PPS tumors is to develop minimally invasive approaches that allow tumor resection without the need for mandibulotomy or lateral skull base approaches. This can be obtained by refining well established surgical routes like the transcervical, improving those with limited applications like the transoral, and developing novel corridors like the transnasal (or the transoral/transvestibular). Therefore, careful surgical planning is mandatory in order to tailor treatment according to the patient and characteristics of the tumor, in view of a wide and heterogeneous choice of techniques (to be employed alone or in combination).

Technical refinements of transcervical and transoral approaches may lead to reduction in the rate of mandibulotomy performed for benign PPS tumors. This is also true when considering the possibility of combined approaches that provide excellent exposure and management of the upper PPS up to the skull base.