Clinical Application Of Surgical Treatment Of Parapharyngeal Space Tumors Via The Endoscopy-assisted Transoral Approach

Parapharyngeal space tumors account for0.5%of head and neck tumors.Benign and malignant tumor is respectively80.0%and20.0%. Most of the patientswith parapharyngeal space tumors are asymptomatic in the early stages. As tumorsgrow, they can result in serious neurological dysfunctions, influencing the life qualityof patients severely.Surgery is the main treatment of parapharyngeal space tumors. The surgicalapproaches used for parapharyngeal space tumors include transoral approach,transcervical approach, transcervical-transparotid approach， transoral-transcervicalapproach，transcervical approach with mandibulotomy，infratemporal fossa approach,maxillary swing approach, lateral skull base approach, and so on. Although there aremany surgical approaches to the parapharyngeal space, none of them completelyfulfills the purposes of a complete tumor removal with low relapse rate, minimal or noscar, and the preservation of the surrounding nerves and vessels. All the externalapproaches obviously produce a cervical or facial scar.This study is to explore the indication, contraindication, surgical skills,advantages and disadvantages of surgical treatment of parapharyngeal space tumorsvia endoscopy-assisted transoral approach through the retrospective analysiscarried out in20patients with parapharyngeal space tumor treated at Shenzhen No.2People’s Hospital in the last six years.Objective: To compare the curative effect difference between the endoscopy-assistedtransoral approach and the transcervical approach of surgical treatment ofparapharyngeal space tumors. Meanwhile, to analysis the indication, contraindication,surgical skills, advantages and disadvantages of the endoscopy-assisted transoralapproach.Objects and Methods：Retrospective analysis were carried out in20patients withparapharyngeal space tumor treated at Shenzhen No.2People’s Hospital from January2008to December2013.20patients were divided into the observation group andthe control group according to the tumor′s location, size and the relationship betweenPPS neoplasm and adjacent structures. In the observation group (5patients), thetumors were removed solely by transoral approach under the guidance of endoscopes,while in the control group (15patients), the neoplasms were excised completely usinga transcervical approach. We compared the total removal rate, the operation time, blood loss, postoperative pain, hospitalized time, complication rate, scar andrecurrence between the two groups. Comparisons were evaluated with the t-test andFisher exact test between the two groups, and p<0.05was considered significant.Result： In the observation group, the operation time, the blood loss and thehospitalized time was (127.009.08) minutes,(86.0012.94) milliliter,(5.800.84)days respectively. While in the control group, the operation time, theblood loss and the hospitalized time was (128.0011.46) minutes,(235.6715.80)milliliter,(9.070.88)days respectively. All the neoplasms werecompletely cut.20Patients were followed up for6months to5yearswith no recurrence. Comparing the total removal rate, the operation time,complication rate, and recurrence rate between the two groups, there were nosignificant differences (P>0.05). The differences in blood loss, hospitalized time andpostoperative pain had statistical sense(P <0.05) between the two groups.Conclusion：Parapharyngeal space neoplasms could be completely cut both throughthe endoscopy-assisted transoral approach and the transcervical approach. Theendoscopy-assisted transoral approach has significantly shorter hospitalized time,less blood loss and less postoperative pain than the transcervical approach. One ofthe biggest advantage of the endoscopy-assisted transoral approach, compared tothe transcervical approach, is the ability to maintain facial cosmetic. So it is thecosmetic technique of minimally invasive surgery. The endoscopy-assisted transoralapproach is a useful technique for the removal of tumors located anteromedially to thethe carotid sheath. However, the endoscopy-assisted transoral approach is notapplicable for all parapharyngeal space neoplasms, such as tumors encasing theinternal carotid arteries and tumors located lateral or posterolateral to the carotidsheath. The endoscopy-assisted transoral approach also apply to biopsy ofparapharyngeal space.