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Benign Parapharyngeal Tumours: Surgical Intricacies by Transcervical Approach

Simple Patadia*,Amitkumar Keshri*,Saurin Shah,Arun Shrivastava

Introduction: Parapharyngeal space (PPS) is one of potential confined fascial planes of head and neck that may be involved by various pathological processes. Being rare, they represent an ominous challenge in its clinical assessment and appropriate surgical intervention.
Material and methods: A study of 14 cases of parapharngeal space tumors (PPST) which presented to our tertiary care Institute from January 2013 to January 2015, were included in this study. All cases were studied by their clinical examination, fine needle aspiration cytology, radiology (computerized tomography and magnetic resonance imaging), extent of excision, postoperative complications and definitive biopsy. All patients underwent surgery by transcervical approach and were followed up for a minimum period of 6 months.
Results: The most common tumour of the parapharyngeal space was pleomorphic adenoma (n=7), followed by schwannomas (n=5), and carotid body tumour (paraganglioma) (n=2). Twelve patients were operated via extracapsular dissection (ECD), and two patients with intracapsular dissection (ICD). Post-operative complications were vocal cord palsy in two cases, marginal mandibular palsy, horner’s syndrome, hypoglossal palsy in one case respectively.
Conclusion: The transcervical approach is a versatile approach for complete excision of tumours with excellent surgical exposure and minimum morbidity. It can also be combined with excision of submandibular gland in order to improve exposure. In cases of large schwannomas, ICD is recommended to favor a complete excision.