Beyond the throat: Imaging of parapharyngeal space lesions

The parapharyngeal space (PPS) is a pyramidal-shaped fat-filled space in the head and neck, between the base of the skull and the hyoid bone. It is a vital anatomic structure in head and neck imaging and serves as a path for the spread of infection or tumor, a critical landmark for diagnosing various lesions in this region, and a potential site of infections. The purpose of this pictorial review is to illustrate the anatomy of the PPS, the pathologies in and around PPS, and the distinguishing imaging characteristics of these lesions. It also explores the limitations and challenges of imaging techniques in certain scenarios as well as the surgical approaches for PPS masses, emphasizing their radiological relevance. The review aims to underscore the significance of a multidisciplinary approach, involving radiologists, otolaryngologists, and head and neck surgeons, in interpreting imaging findings and determining the most appropriate management strategies for PPS lesions for improved patient outcomes.