Dissection of parapharyngeal space in head and neck cancer

The parapharyngeal space is a potential space located lateral to the upper pharynx and tonsillar area. This space can be involved either by direct extension, by perineural or neural spread, or by lymph node metastasis from cancers originating in adjacent sites. Between 1978 and 1984, 22 patients with T3 or T4 carcinoma of the head and neck region underwent dissection of the parapharyngeal space in conjunction with ablation of the primary tumor and standard radical neck dissection. Twelve of these patients had carcinoma arising in the oral cavity, 4 in the oropharynx, and 6 in the major salivary glands. Surgical approaches applied to the dissection of the space were the submandibular route combined with the transoral approach in 1 patient, transparotid in 3, the mandibular "swing" approach in 9, and mandibular composite resection in 9. The last 2 approaches allowed excellent control of the neurovascular structures up to their entrance into the skull base. In 18 patients of this series, the tumor was locoregionally controlled in 5 to 77 months (median 23 months) of follow-up. Dissection of the parapharyngeal space improves locoregional control rate of advanced head and neck cancers involving this space.