From July 2004 to July 2009, a retrospective review of 45 patients with
neoplasms of parapharyngeal space was performed. Fourty-five cases were examined by CT, some of them were examined by MRI or DSA. Several surgical approaches were selected. The transcervical approach was used in 35 cases, the transparotid approach was used in 5 cases, the transmandible approach was used in 2 cases, and the transparotid and temporal approach was used in 3 cases.
RESULT: Among 45 patients, 37 cases (82.22%) were benign and 8 cases (17.78%) were malignant. Neurogenic
neoplasms and salivary glands
neoplasms were the most common
tumors. Using CT, MRI or DSA could obtain useful information about the location, size, shape, density and degree of enhancement of the parapharyngeal space
neoplasms, acquire their relationship with styloid and carotid, and make preoperative diagnosis. The diagnostic coincidence rate between preoperative diagnosis and pathological diagnosis was 80% (origin of tissue). All benign
tumors were completely resected. A
lymphangiomas had recurrence after 1 year,and the second operation had no recurrence. In the 45 cases, 8 cases were malignant
tumors. Of 2 patients with
malignant mixed tumors, 1 survived disease free after a follow-up of 4 years,and another was still alive with disease after a follow-up of 3 years; Of 2 patients with
synovial sarcomas, 1 survived disease free for a follow-up of 3 years, the other one survived disease free after a follow-up of 2 years; 1 patient of
nasopharyngeal carcinoma with
metastasis in the parapharyngeal space had post-operative radical
radiotherapy and survived disease free after a follow-up of 5 years. One patient with
chordoma was still alive with disease after a follow-up of 3 years; 1 patient with poorly differentiated
squamous cell carcinoma, died of pulmonary
metastasis after a 4 year follow-up; 1 case with
follicular dendritic cell sarcoma survived disease free after a follow-up of 2 years.
CONCLUSION: CT, MRI and DSA are essential for the diagnosis and differentiation of parapharyngeal space
neoplasm. The transcervical approach is a simple, safe and minimal invasive procedure for resecting parapharyngeal space
neoplasms. It is the best approach for treatment of parapharyngeal space
neoplasms.