Trans oral endoscopic surgery (TOES) of para-pharyngeal space tumours: single surgeon experience

Parapharyngeal (PP) tumours are rare and form 0.5% of head and neck pathology. The anatomy of PPS is divided into pre-styloid space and post-styloid which contains the carotid sheath, lower four cranial nerves and the sympathetic chain. The pathology of the PP space is heterogenous, but the majority are benign mainly from the deep lobe of the parotid. The purpose of our study was to map our experience of performing transoral endoscopic surgery (TOES) for removing these tumours and highlight some potential benefits over traditional transcervical approaches.

Retrospective study looking at 9 patients operated on by a single head and neck surgeon for benign pre-operative investigations after discussion in a multidisciplinary team setting. Data was collected such as gender distribution, size and laterality of tumour, post operative histology and whether there was recurrence or incomplete excision.

9 patients ( Male = 6, Female = 3, Age 47) were operated on via TOES. Their average tumour sizes were 46 × 36 mm with a right sided predominance N = 7. Post operatively 78% (N = 7) were benign in histology with 11% ( N = 1) requiring revision surgery for recurrence and 11% (N = 1) having incomplete excision.

TOES is advantageous as it is minimally invasive surgery (MIS), scar less, associated with quicker recovery, shorter length of stay (LOS) and subsequently is cost effective. However, it has also its drawbacks like being suitable in only selective cases, limited approach, the need for special instruments, being an unclean procedure and finally its learning curve.