Analysis Of Clinical Features And Surgical Approach Of Parapharyngeal Space Tumors

Objective:Through analyzing the clinical case data of 43 patients,we analyzed the clinical characteristics of parapharyngeal space tumors,including clinical manifestations,imaging examinations,pathological types,surgical methods,postoperative complications and prognosis,to provide a basis for the diagnosis and treatment of parapharyngeal space tumors.Methods:The case data of 64 patients with parapharyngeal space tumors admitted to the Department of Otolaryngology-Head and Neck Surgery of a hospital between November 2011 and August 2022 were retrospectively analyzed,and patients with incomplete imaging and pathology were excluded,and a total of 43 cases were included in the study,including 26 male patients and 17 female patients,aged 21-81 years,with a mean age of 48 years.The collection included patients’ clinical symptoms(complaints),signs,physical examination,specialist examination,imaging examination,preoperative puncture biopsy,operative records,operative duration,intraoperative bleeding,postoperative pathology,hospitalization days,and postoperative complications.All patients underwent preoperative MRI examination,and 6 cases underwent both MRI and CT examination.The clinical presentation,preoperative imaging assessment,postoperative pathology type,surgical pathway selection,postoperative complications and their prognosis were summarized and analyzed.Results:The most common symptoms in 43 patients were cervical swelling and foreign body sensation in the pharynx,and the most common signs were cervical swelling and lateral wall bulge on one side of the pharynx,which were performed by lateral cervical approach,transcervical-parotid approach,transoral approach,mandibulotomy approach and intraoral combined with external cervical approach.The bleeding is higher in the external cervical approach compared to the intraoral approach.Postoperative pathology suggested 38 cases of benign tumors containing10 pathologies and 5 cases of malignant tumors containing 3 pathologies.Among them,tumors of neurogenic origin and tumors of salivary gland origin were more common.Preoperative imaging was performed in 26 cases of tumors located in the posterior interstitial space of the caudate,most of which were neurogenic tumors;17 cases of tumors located in the anterior interstitial space of the caudate,most of which were salivary gland-derived tumors,and the difference was statistically significant.Postoperative complications were common with various nerve injuries,and facial palsy was the most common.There was no significant difference in the incidence of postoperative complications among different surgical procedures(P>0.05).The follow-up rate of patients was81.40%,among which 3 cases showed recurrence,2 cases did not see recurrence after reoperation,and 1 patient had 4 recurrences,all of which were operated again.Conclusion:1.Parapharyngeal space tumors are rare,accounting for 0.5-1% of the whole head and neck tumors,mostly benign tumors,and the incidence of benign and malignant tumors in different genders is not statistically significant.2.Among the parapharyngeal space tumors,neurogenic tumors and tumors of salivary gland origin are the most common,and most of the parapharyngeal space tumors can be removed by the lateral cervical approach.3.Nerve sheath tumors are the most common type of parapharyngeal space tumors,and MRI has a very high accuracy in assessing the nerve of origin of nerve sheath tumors.On imaging,vagal nerve sheath tumors usually separate the internal carotid artery from the internal jugular vein,whereas sympathetic nerve sheath tumors usually nudge these vessels together,which is statistically significant.4.On the imaging manifestations,malignant tumors were more likely to have indistinct tumor margins than benign tumors,neurogenic tumors were more likely to occur in the posterior stem space than non-neurogenic tumors,and salivary gland-derived tumors were more likely to occur in the anterior stem space than non-salivary gland-derived tumors,and the differences were statistically significant.5.The intraoperative bleeding volume of the external cervical approach is significantly higher than that of the intraoral approach,and the treatment plan should be selected after a comprehensive weighing of the advantages and disadvantages of surgery.