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Learning Modern Laryngeal Surgery in a Dissection Laboratory
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Embracing the Transoral Parapharyngeal Space Surgery (TOPPSS).

Devendra Kumar Gupta1, Mahesh Ravunnikutty1, Rajeev Chugh1

  • 1Department of ENT HNS, Army Hospital Research and Referral, New Delhi, 110010 India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|March 11, 2025
PubMed
Summary

The DK et al. TOPPSS Criteria improve patient selection for transoral parapharyngeal space surgery (TOPPSS). This approach, enhanced by endoscopy and a novel flap, ensures favorable outcomes for parapharyngeal tumors.

Keywords:
AdenomaEndoscopyParapharyngeal spacePleomorphicTransoral

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Area of Science:

  • Otolaryngology
  • Head and Neck Surgery
  • Surgical Oncology

Background:

  • Transoral Parapharyngeal Space Surgery (TOPPSS) is utilized for parapharyngeal tumors but faces limitations due to restricted exposure and potential complications.
  • Effective patient selection and surgical technique refinement are crucial for optimizing TOPPSS outcomes.

Purpose of the Study:

  • To introduce and validate the 'DK et al. TOPPSS Criteria' for selecting patients suitable for transoral parapharyngeal space surgery.
  • To evaluate the efficacy and safety of TOPPSS, augmented with endoscopic assistance and a new flap technique, for treating parapharyngeal tumors.

Main Methods:

  • Development of the 'DK et al. TOPPSS Criteria' based on clinic-radio-pathological factors (tumor nature, site, extent, capsule, neurovascular involvement, cytopathology, vascularity, mouth opening).
  • Application of the criteria to select 13 patients with parapharyngeal tumors for TOPPSS.
  • Integration of endoscopic visualization and the proposed DK et al. Anterior Tonsillar Myo-mucosal (ATM) flap during surgery.

Main Results:

  • All 13 patients treated with TOPPSS according to the criteria demonstrated favorable outcomes.
  • Key positive outcomes included complete tumor excision, reduced operation time, minimal blood loss, low complication rates, shorter hospital stays, and effective wound healing.
  • Endoscopic assistance and the ATM flap facilitated neurovascular structure preservation and improved wound healing.

Conclusions:

  • The 'DK et al. TOPPSS Criteria' are essential for comprehensive preoperative evaluation and proper patient selection, enhancing the success of TOPPSS.
  • Endoscopic assistance significantly improves visualization and enables safe resection, preserving critical neurovascular structures.
  • The proposed DK et al. ATM flap aids in primary wound healing, allows early oral intake, and protects exposed neurovascular structures.