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Contemporary evaluation and management of parapharyngeal space neoplasms

Published online by Cambridge University Press:  10 April 2013

D W Eisele  and
J D Richmon
D W Eisele*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
J D Richmon
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
*
Address for correspondence: Professor D W Eisele, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N Caroline Street, Suite 6210, Baltimore, MD 21287, USA E-mail: deisele1@jhmi.edu
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Abstract

Objective:

This review summarises the contemporary, multidisciplinary approach to managing parapharyngeal space neoplasms.

Overview:

Parapharyngeal space neoplasms are uncommon head and neck tumours and are most often benign. Most tumours are of either salivary gland or neurogenic origin. Patients tend to be asymptomatic even when tumours reach large sizes. Patients may present with a mass in the pharynx or neck, although frequently the tumour is found incidentally on an imaging study. Due to the limitations of physical examination in this anatomical area, imaging studies are essential to the evaluation of parapharyngeal space neoplasms. Cytopathology may provide additional diagnostic information. Open biopsy is rarely necessary and can be hazardous. Treatment is primarily surgical, and various surgical approaches can be tailored for a given neoplasm. Recently, a trend toward observation of select patients with asymptomatic neurogenic tumours has been advocated.

Conclusion:

The evaluation and management of parapharyngeal space tumours is best done by a multidisciplinary team. Treatment should be individualised, and the risks and benefits of surgical intervention need to be carefully weighed. Complications are best avoided by careful surgical planning.

Keywords

NeoplasmsSalivary GlandsSchwannomaParagangliomaVagus NerveReview
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 6 , June 2013 , pp. 550 - 555
Copyright
Copyright © JLO (1984) Limited 2013 

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Footnotes

Professor D W Eisele is one of the JLO 2013 Visiting Professors

Presented at the Royal Society of Medicine Section of Laryngology and Rhinology, 3 May 2013, London, UK

References

1Batsakis, JG, Sneige, N. Parapharyngeal and retropharyngeal space diseases. Ann Otol Rhinol Laryngol 1989;98:320–1CrossRefGoogle ScholarPubMed
2Pensak, ML, Gluckman, JL, Shumrick, KA. Parapharyngeal space tumors: an algorithm for evaluation and management. Laryngoscope 1994;104:1170–3CrossRefGoogle ScholarPubMed
3Carrau, RL, Johnson, JT, Myers, EN. Management of tumors of the parapharyngeal space. Oncology 1997;11:633–40Google ScholarPubMed
4Cohen, SM, Burkey, BB, Netterville, JL. Surgical management of parapharyngeal space masses. Head Neck 2005;27:669–75CrossRefGoogle ScholarPubMed
5Shahab, R, Heliwell, T, Jones, AS. How we do it: a series of 114 primary pharyngeal space neoplasms. Clin Otolaryngol 2005;30:364–7CrossRefGoogle Scholar
6Carrau, RL, Myers, EN, Johnson, JT. Management of tumors arising in the parapharyngeal space. Laryngoscope 1990;100:583–9CrossRefGoogle ScholarPubMed
7Farrag, TY, Lin, FR, Koch, WM, Califano, JA, Cummings, CW, Farinola, MA et al. The role of pre-operative CT-guided FNAB for parapharyngeal space tumors. Otolaryngol Head Neck Surg 2007;136:411–14CrossRefGoogle ScholarPubMed
8Gupta, A, Chazen, JL, Phillips, CD. Imaging evaluation of the parapharyngeal space. Otolaryngol Clin North Am 2012;45:1223–32CrossRefGoogle ScholarPubMed
9Furukawa, M, Furukawa, MK, Katoh, K, Tsukuda, M. Differentiation between schwannoma of the vagus nerve and schwannoma of the cervical sympathetic chain by imaging diagnosis. Laryngoscope 1996;106:1548–52CrossRefGoogle ScholarPubMed
10Saito, DM, Glastonbury, CM, El-Sayed, IH, Eisele, DW. Parapharyngeal space schwannomas: preoperative imaging determination of the nerve of origin. Arch Otolaryngol Head Neck Surg 2007;133:662–7CrossRefGoogle ScholarPubMed
11Oliai, BR, Sheth, S, Burroughs, FH, Ali, SZ. “Parapharyngeal space” tumors: a cytopathological study of 24 cases on fine-needle aspiration. Diagn Cytopathol 2005;32:11–15CrossRefGoogle ScholarPubMed
12Lau, WF, Lam, KH, Wei, W. Parapharyngeal space tumours. Aust N Z J Surg 1986;56:835–42CrossRefGoogle ScholarPubMed
13Ducic, Y, Oxford, L, Pontius, AT. Transoral approach to the superomedial parapharyngeal space. Otolaryngol Head Neck Surg 2006;134:466–70CrossRefGoogle Scholar
14O'Malley, BW Jr, Quon, H, Leonhardt, FD, Chalian, AA, Weinstein, GS. Transoral robotic surgery for parapharyngeal space tumors. ORL J Otorhinolaryngol Relat Spec 2010;72:332–6CrossRefGoogle ScholarPubMed
15Arshad, H, Durmus, K, Ozer, E. Transoral robotic resection of selected parapharyngeal space tumors. Eur Arch Otorhinolaryngol 2012; Oct 16Google ScholarPubMed
16Lee, HS, Kim, J, Lee, HJ, Koh, YW, Choi, EC. Transoral robotic surgery for neurogenic tumors of the prestyloid parapharyngeal space. Auris Nasus Larynx 2012;39:434–7CrossRefGoogle ScholarPubMed
17DeVirgilio, A, Park, YM, Kim, WS, Byeon, HK, Lee, SY, Kim, SH. Transoral robotic surgery for the resection of parapharyngeal tumour: our experience in ten patients. Clin Otolaryngol 2012;37:470–96Google Scholar
18Chan, JY, Li, RJ, Lim, M, Hinojosa, AQ, Boahene, KD. Endoscopic transvestibular paramandibular exploration of the infratemporal fossa and parapharyngeal space: a minimally invasive approach to the middle cranial base. Laryngoscope 2011;121:2075–80CrossRefGoogle Scholar
19Goodwin, WJ Jr, Chandler, JR. Transoral excision of lateral parapharyngeal space tumors presenting intraorally. Laryngoscope 1988;98:266–9CrossRefGoogle ScholarPubMed
20Allison, RS, Van der Waal, I, Snow, GB. Parapharyngeal tumours: a review of 23 cases. Clin Otolaryngol Allied Sci 1989;14:199–203CrossRefGoogle ScholarPubMed
21Betka, J, Chovanec, M, Klozar, J, Taudy, M, Plzák, J, Kodetová, D et al. Transoral and combined transoral-transcervical approach in the surgery of parapharyngeal tumors. Eur Arch Otorhinolaryngol 2010;267:765–72CrossRefGoogle ScholarPubMed
22Chang, SS, Goldenberg, D, Koch, WM. Transcervical approach to benign parapharyngeal space tumors. Ann Otol Rhinol Laryngol 2012;121:620–4CrossRefGoogle ScholarPubMed
23Malone, JP, Agrawal, A, Schuller, DE. Safety and efficacy of transcervical resection of parapharyngeal space neoplasms. Ann Otol Rhinol Laryngol 2001;110:1093–8CrossRefGoogle ScholarPubMed
24Beswick, DM, Vaezi, A, Caicedo-Granados, E, Duvvuri, U. Minimally invasive surgery for parapharyngeal space tumors. Laryngoscope 2012;122:1072–8CrossRefGoogle ScholarPubMed
25Bozza, F, Vigili, MG, Ruscito, P, Marzetti, A, Marzetti, F. Surgical management of parapharyngeal space tumours: results of 10-year follow-up. Acta Otorhinolaryngol Ital 2009;29:10–15Google Scholar
26Zhi, K, Ren, W, Zhou, H, Wen, Y, Zhang, Y. Management of parapharyngeal-space tumors. J Oral Maxillofac Surg 2009;67:1239–44CrossRefGoogle ScholarPubMed
27Jungehuelsing, M, Guntinas-Lichius, O, Klussmann, JP, Eckel, HE, Stennert, E. Modifications of the midline mandibulotomy for access to the parapharyngeal space. Laryngoscope 2010;120:1557–62CrossRefGoogle Scholar
28Lazaridis, N, Antoniades, K. Condylotomy or vertical subsigmoid osteotomy with a mandibulotomy anterior to the mental foramen for improved access to parapharyngeal space tumors. J Oral Maxillofac Surg 2008;66:597–606CrossRefGoogle ScholarPubMed
29Zitsch, RP 3rd, Patenaude, B, Tidmore, T. An extraoral parapharyngeal space approach via vertical ramus osteotomy. Am J Otolaryngol 2007;28:330–3CrossRefGoogle ScholarPubMed
30Smith, GI, Brennan, PA, Webb, AA, Ilankovan, V. Vertical ramus osteotomy combined with a parasymphyseal mandibulotomy for improved access to the parapharyngeal space. Head Neck 2003;25:1000–3CrossRefGoogle Scholar
31Kolokythas, A, Eisele, DW, El-Sayed, I, Schmidt, BL. Mandibular osteotomies for access to select parapharyngeal space neoplasms. Head Neck 2009;31:102–10CrossRefGoogle ScholarPubMed
32Valentino, J, Boggess, MA, Ellis, JL, Hester, TO, Jones, RO. Expected neurologic outcomes for surgical treatment of cervical neurilemomas. Laryngoscope 1998;108:1009–13CrossRefGoogle ScholarPubMed
33Kang, GC, Soo, KC, Lim, DT. Extracranial non-vestibular head and neck schwannomas: a ten-year experience. Ann Acad Med Singapore 2007;36:233–8CrossRefGoogle ScholarPubMed
34de Araujo, CE, Ramos, DM, Moyses, RA, Durazzo, MD, Cernea, CR, Ferraz, AR. Neck nerve trunks schwannomas: clinical features and postoperative neurologic outcome. Laryngoscope 2008;118:1579–82CrossRefGoogle ScholarPubMed
35Kim, SH, Kim, NH, Kim, KR, Lee, JH, Choi, HS. Schwannoma in head and neck: preoperative imaging study and intracapsular enucleation for functional nerve preservation. Yonsei Med J 2010;51:938–42CrossRefGoogle ScholarPubMed
36Urquhart, AC, Johnson, JT, Myers, EN, Schechter, GL. Glomus vagale: paraganglioma of the vagus nerve. Laryngoscope 1994;104:440–5CrossRefGoogle ScholarPubMed
37Jansen, JC, van den Berg, R, Kuiper, A, van der Mey, AG, Zwinderman, AH, Cornelisse, CJ. Estimation of growth rate in patients with head and neck paragangliomas influences the treatment proposal. Cancer 2000;88:2811–163.0.CO;2-7>CrossRefGoogle ScholarPubMed
38Bradshaw, JW, Jansen, JC. Management of vagal paraganglioma: is operative resection really the best option? Surgery 2005;137:225–8CrossRefGoogle ScholarPubMed
39Langerman, A, Athavale, SM, Rangarajan, SV, Sinard, RJ, Netterville, JL. Natural history of cervical paragangliomas: outcomes of observation of 43 patients. Arch Otolaryngol Head Neck Surg 2012;138:341–5Google ScholarPubMed
40Kahn, LB. Vagal body tumor (nonchromaffin paraganglioma, chemodectoma, and carotid body-like tumor) with cervical node metastasis and familial association: ultrastructural study and review. Cancer 1976;38:2367–773.0.CO;2-3>CrossRefGoogle ScholarPubMed
41Hinerman, RW, Amdur, RJ, Morris, CG, Kirwan, J, Mendenhall, WM. Definitive radiotherapy in the management of paragangliomas arising in the head and neck: a 35-year experience. Head Neck 2008;30:1431–8CrossRefGoogle ScholarPubMed
42Foote, RL, Pollock, BE, Gorman, DA, Schomberg, PJ, Stafford, SL, Link, MJ et al. Glomus jugulare tumor: tumor control and complications after stereotactic radiosurgery. Head Neck 2002;24:332–8CrossRefGoogle ScholarPubMed
43Olsen, KD. Tumors and surgery of the parapharyngeal space. Laryngoscope 1994;104:1–28CrossRefGoogle ScholarPubMed
44Moore, EJ, Olsen, KD. Complications of surgery of the parapharyngeal space. In: Eisele, DW, Smith, RJ, eds. Complications in Head and Neck Surgery, 2nd edn.Philadelphia: Mosby Elsevier, 2009;241–50CrossRefGoogle Scholar
45Netterville, JL, Vrabec, JT. Unilateral palatal adhesion for paralysis after high vagal injury. Arch Otolaryngol Head Neck Surg 1994;120:218–21CrossRefGoogle ScholarPubMed
46Gardner, WJ, Abdullah, AF. Parotid pain following superior cervical ganglionectomy: a clinical example of the antagonistic action of the parasympathetic and sympathetic systems. Am J Med Sci 1955;230:65–9CrossRefGoogle ScholarPubMed
47Haubrich, WS. The first-bite syndrome. Henry Ford Hosp Med J 1986;34:275–8Google ScholarPubMed
48Netterville, JL, Jackson, CG, Miller, FR, Wanamaker, JR, Glasscock, ME. Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg 1998;124:1133–40CrossRefGoogle Scholar
49Chiu, AG, Cohen, JI, Burningham, AR, Andersen, PE, Davidson, BJ. First bite syndrome: a complication of surgery involving the parapharyngeal space. Head Neck 2002;24:996–9CrossRefGoogle ScholarPubMed
50Albasri, H, Eley, KA, Saeed, NR. Chronic pain related to first bite syndrome: report of two cases. Br J Oral Maxillofac Surg 2011;49:154–6CrossRefGoogle ScholarPubMed
51Ali, MJ, Orloff, LA, Lustig, LR, Eisele, DW. Botulinum toxin in the treatment of first bite syndrome. Otolaryngol Head Neck Surg 2008;139:742–3CrossRefGoogle ScholarPubMed
52Lee, BJ, Lee, JC, Lee, YO, Wang, SG, Kim, HJ. Novel treatment of first bite syndrome using botulinum toxin type A. Head Neck 2009;31:989–93CrossRefGoogle ScholarPubMed