| Objective: Parapharyngeal Space(PPS) is a deep potential crateriform interfascial space of lateral pharynx and upper neck. It lies very deeply and it's framework is complex, in which there are internal carotid artery, external carotid artery, internal jugular vein, sympathetic nerve, cranial nerves Ⅸ to Ⅻ, lymphoglandulae cervicales profundae superiors and other important framework. Through analyzing the clinical data of tumor in the parapharyngeal space to improve the diagnostic and curative level of tumor in the parapharyngeal space and reduce the postoperative complications. Methods: The data of 138 patients in our department who presented with tumor in the parapharyngeal space between January 1988 and January 2005 were gathered, not including metastatic tumor in the parapharyngeal space and nasopharyngeal carcinoma invading the nasopharyngeal carcinoma. There were 83 male and 55 female, age ranged from 7 to 73 years, and the mean age is 44.7 years, in whom there were 12 patients done by operation for two times because of postoperative recurrence. 63 patients underwent fine needle aspiration cytology (FNAC) before operation. All the patients underwent CT or MRI. 38 patients underwent fibrous (electric) epipharyngoscopic and laryngoscopic examination. Patients who suffered from malignant tumor underwent radiotherapy and chemotherapy. All the patients were followed up, and the following-up lasted 10 months to 15 years. Results: ①In 138 cases, benign tumors constituted 87.69% while malignant tumors 12.32%. In benign tumors, pleomorphic adenoma and neurinomatosis were the most common tumors, constituted 38.41% and 32.61% respectively. ② The clinical symptoms were discomfort of pharynx, foreign body sensation in pharynx and snoring, constituted 59.34% and 52.90% respectively, and patients without symptoms constituted 24.64%. ③ Physical signs were touching masses of pharynx, ingression of lateral pharyngeal wall, masses of neck, collapse of soft palate, stenosis of pharyngonasal cavity, constituted 35.51%, 31.16%, 29.71%, 27.54% and 23.19% respectively. ④The cytological diagnosis of 47 cases was accorded with the pathological and follow-up results, 16 cases were unconformity with the pathological diagnosis. The diagnostic accuracy, sensitivity and specificity were 74.60%, 73.78% and 100%. ⑤ Postoperative complications were bucking, loll deviation, Horner's syndrome, postoperative infection and hoarseness, constituted 10.87%, 8.70%, 5.80%, 5.07% and 5.07% respectively. ⑥CT and MRI images well provided the position, size, confine, velvet of tumor edge and the relationship between tumor and important peripheral structure. They are important to the formulation of operation program. ⑦All of the 138 patients underwent operation. In 121 patients who suffer from benign tumors, 12 tumors recurred. The recurrent patients didn't recur again after the second operation. Most complications such as hoarseness and bucking recovered in half a year after operation. In 17 patients who suffered from malignant tumors, 14 patients survived by 1 year(82.35%), 11 patients 2 years(64.71%), 9 patients 3 years (52.94%), 6 patients 5 years (35.29%). Conclusion: Clinical symptoms of tumor in the parapharyngeal space vary much, uncharacteristically. The character of tumor is almost benign and pleomorphic adenoma is the most common tumor. CT and MRI images well provided the position, size, confine, velvet of tumor edge and the relationship between tumor and important peripheral structure. FNAC is accurate in diagnosing the character of tumor and it's fast, safe and economic. The treatment of PPS tumor is primarily exairesis by the transoral approach, cervical approach, cervical-parotid approach, mandible split swing approach and maxillary swing approach. The selection of approach is important to the success of operation. The rules of selecting approach are the most exposing of tumors to ectomize them completely and the least damage in function and shape. Recently the cervical approach is the most primary approach to actomize PPS tumor. If patients with tumor in the parapharyngeal space suffered from obvious angina, headache and fever, malignant tumors should be considered. The prognosis of benign tumors is good, while the five-year survival rate is 35.29% of the malignant tumors.
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