Clinical Analysis Of Parapharyngeal Space Neoplasms (Analysis Of 44 Cases)

Objective: To make clear anatomic features of the parapharyngeal space and relationship between the tumor and it, explore the diagnosis and treatment of parapharyngeal space tumors, and improve the level of them.Methods: Retrospective survey was done on 44 patients with parapharyngeal space tumors operated from May 1994 to February 2008. male 19, female 25, mean age 40.42 years old. Benign tumors 31 cases: myoschwannoma 17 cases, pleomorphic adenoma 10 cases, haemangioma 1 case, false sneurysm 1 case, fibroma 2 cases; malignant tumor 13 cases:metastatic carcinoma 6 cases, hemangiopericytoma 1 case, malignant lymphadenoma 3 cases, fibroma sarcomatosum 1 case, rhabdomysarcoma 1 case, parapharyngeal space infested by malignant meningioma 1 case.With mass in pharyngeal or cervical portion as the first symptom mostly, there were mass in pharynx oralis, mass in cervical portion, indisposition of oral pharynx, speech disorder, difficult in opening mouth, headache, pharyngalgia or cervicodynia, desfness, bombus, trachyphonia, bucking and so on. course of disease was from fifteen days to 14 years.The rate of misdiagnosis was 43.18%(19/44).In special examination,boss of lateral pharyngeal wall,aversion of amygdale and palatum molle and so on can be founded.Ultrasonic inspection, laryngo-pharyngoscopy, CT, MRI, CTA and MRA were examined. All of the patients were undergone the operation,with peroral pharynx or percervicolateral approach mainly, diagnoised by fast frozen section or pathological report.Results: The age section of highest arrack rate is from 31 to 50 years old (44.19%). The pathotype of parapharyngeal tumors is complicated. Benign tumors 31 cases : myoschwannoma with the highest proportion, nearly 38.64%;malignant tumor 13 cases.The auxiliary examinations such as ultrasound,CT,MRI,could show the condition of the tumor almost clearly. The tumors were excised completely in 39 patients. Palliative radiation therapy were applied in 5 patients with malignant tumor couldn't be excised.Post-operation complications including immaturity facial peripheral paralysis,hoarse voice, bucking, deciation of extending tongue,Horner syndrome,swell of face and et al.The rate of patient follow-up was 86.36% (38/44), benign 90.32%, malignant 76.92% (10/13), from 4 to 14 months. Recurrence was found in 7 cases and 5 of them cured by reoperations.Conclusions: The clinical manifestations of parapharyngeal tumors were complex, the pathotypes were variable, so the early diagnosis was difficult. It needed to combine the CT or MRI and other auxiliary examinations, expect the clinical symptom and objective sign, to find the tumor early which can improve the diagnosis of parapharngeal tumors,and can imply more important reference views.To select eligible approach of operation on the basis of the location, extent of invaded and pathological type of the tumor, and evaluate pre-operation comprehensively, can prevent or degrade the occurrence of postoperative complications.