Transcervical endoscopic approach for parapharyngeal space: a cadaver study and clinical practice

Background: The traditional transcervical approach is frequently applied but limited in handling the tumors in parapharyngeal space.Objectives: We explore a new transcervical endoscopic approach with more direct visualization, less complications, and better outcomes.Material and methods: Eight cadaver heads (sixteen sides) were prepared for endoscopic dissection. Clinical cases were carefully selected, and thirty patients accepted the transcervical endoscopic surgery.Results: The transcervical approach with an endoscopic video system clearly exposed the detailed structures in the parapharyngeal space. The stylopharyngeus, styloglossus muscles, and styloid process were critical landmarks in this approach. During the thirty cases of clinical surgeries, internal carotid arteries and cranial nerves could be effectively exposed and protected with the endoscopic video system. Accurate hemostasis could be achieved under endoscopic transcervical approach with a mean amount between 30 to 100 ml of hemorrhaging. There was no postoperative hemorrhages and emergency tracheotomies. The follow up led to promising results.Conclusions and significance: The transcervical endoscopic approach provides a wide corridor for surgery in the parapharyngeal space. With accurate hemostasis, this approach can be applied as the first-line strategy for parapharyngeal surgeries in selected patients.