Surgical anatomy of the parapharyngeal space: Multiperspective, quantification-based study

Area of Science:

• Anatomy
• Surgical Oncology
• Head and Neck Surgery

Background:

• The parapharyngeal space (PPS) is a complex anatomical region requiring various surgical approaches.
• A lack of objective data exists regarding the advantages and limitations of different surgical routes to the PPS.

Purpose of the Study:

• To objectively describe and compare the advantages and limitations of various surgical approaches to the parapharyngeal space (PPS).
• To provide a systematization of surgical approaches based on target location within the PPS.

Main Methods:

• Dissection of ten cadaver heads evaluating transnasal, transoral, transcervical, and infratemporal approaches.
• Analysis of encountered neurovascular and musculoskeletal structures.
• Navigation-based quantification of working volume and exposure of PPS compartments.

Main Results:

• Transnasal approaches provided limited exposure of the upper PPS.
• Transoral approaches offered middle PPS exposure with minimal neurovascular compromise.
• Transcervical and skull base approaches afforded complete PPS exposure but involved crossing more neurovascular structures.

Conclusions:

• Surgical approach selection for the parapharyngeal space (PPS) should be tailored to the specific resection target.
• Unicompartmental PPS resections may be achievable with conservative, single-access techniques.
• Multicompartmental dissections in the PPS often necessitate wider or multiportal surgical strategies.