Surgical treatment of primary parapharyngeal space tumors: a clinical study of 106 cases

Parapharyngeal space tumors present significant clinical challenges due to their deep anatomical location, diverse pathological types, and proximity to critical neurovascular structures, including cranial nerves and the internal carotid artery. While surgical resection is the primary treatment, it is associated with substantial risks of damaging these adjacent structures. Therefore, careful surgical planning and meticulous intraoperative technique are essential to minimize complications. A retrospective review was conducted on 106 patients with parapharyngeal space tumors treated at the Affiliated Hospital of Qingdao University from 2014 to 2024. This study evaluated parapharyngeal space (PPS) tumors in terms of clinicopathological features, preoperative imaging findings, surgical approach selection, perioperative complications and long-term recurrence patterns. Among 106 patients (61 males, 45 females; median age: 36.8 years), neck swelling was the most common symptom. Salivary gland tumors (45.3%) and neurogenic tumors (42.5%) predominated. Malignant tumors were found in 9.4% of cases. The transcervical-transparotid approach was most frequently employed (50.9%). For larger or deeper tumors, vertical ramus osteotomy provided enhanced exposure with minimal morbidity. Surgical resection remains the cornerstone of treatment for PPS tumors, achieving favorable outcomes with low recurrence and mortality rates. The selection of surgical approach depends on several factors including tumor size, precise location, proximity to major vessels, and suspicion of malignancy. While the transcervical-transparotid approach is the most common technique for benign lesions, it is imperative that surgical strategy is adapted to the individual patient's anatomy, and surgeon expertise is paramount for a successful outcome.