Transoral Robotic Surgical Resection of Bilateral Parapharyngeal Space Rhabdomyoma

The parapharyngeal space is a surgically challenging anatomic compartment with critical neurovascular structures with limited access options that often requires an open transcervical skull base approach, often in combination with parotidectomy and/or a transoral approach. As such, lesions in this area must be carefully approached and represent a challenge even for experienced surgeons. Isolated transoral approaches have been used but are often limited by visualization of the deeper structures of the parapharyngeal space. While transoral robotic resection has been used to approach the parapharyngeal space, it must be performed after careful patient selection.

We present a patient with massive bilateral rhabdomyoma of the parapharyngeal space who presented following dysphagia. A minimally invasive transoral approach was used to successfully remove both tumors simultaneously. This patient successfully underwent removal of bilateral tumors using a completely transoral robotic-assisted approach. The patient experienced no long-term sequela including dysphagia, bleeding, cranial neuropathy, and airway distress. A literature search regarding bilateral parapharyngeal space tumors and transoral approaches to the parapharyngeal space was performed to examine the rarity, safety, and efficacy of the approach. This represents the only report of such pathology as well as the only report of a simultaneous bilateral parapharyngeal space approach with transoral robotic surgical assistance.

Bilateral parapharyngeal space tumors are an incredibly rare phenomenon. Following careful patient selection and postoperative monitoring, removal of bilateral tumors can be performed in a safe and successful manner without complication, morbidity, or external incision.