Embracing the Transoral Parapharyngeal Space Surgery (TOPPSS)

Transoral Parapharyngeal Space Surgery (TOPPSS) is often opted by surgeons for parapharyngeal tumors. But its broad implementation is curtailed by limited exposure and the potential for various complications to arise. In this article, authors have outlined the 'DK et al. TOPPSS Criteria' encompassing several clinic-radio-pathological elements for consideration, while opting the transoral approach based on literature and references therein. 'DK et al. TOPPSS Criteria' encompasses factors including nature, site and extent of tumour, capsule, involvement of neurovascular structures, cytopathology, vascularity, and mouth opening. Thirteen patients diagnosed with parapharyngeal tumors were selected as per the proposed criteria and were subsequently subjected to TOPPSS. Additionally, an endoscope was incorporated to enhance visualization. All patients exhibited favourable outcomes in terms of complete excision, operation time, blood loss, complications, hospital stay, wound healing, and follow-up. TOPPSS is an invaluable and evolving technique which yields favourable outcomes when carefully applied. Comprehensive preoperative evaluation and proper patient selection using the 'TOPPSS Criteria' remain essential to the success of this approach. The use of endoscopic assistance further enhances its capabilities, allowing for effective resection with preservation of critical neurovascular structures. Authors have also proposed the DK et al. Anterior Tonsillar Myo-mucosal (ATM) flap, that can be easily elevated, conserved, and repositioned; serving to enhance primary wound healing, enable early oral intake and prevent the exposure of neurovascular structures within the tumor bed.