The Analysis Of Diagnosis And Treatment Of 80 Cases Of Primary Parapharygeal Sapce Tumors

ObjectiveTo analysis the diagnosis and treatment of the cases of primary parapharyngeal tumors, and to discuss the choosing of best opearating method, in order to induce the occurrence of complications.MethodsA retrospective review of 80 patients, who suffered from primary parapharngeal tumors and underwent operation treatment, and after which was diagnosed by pathology in Qilu Hospital of Shandong University from June,2004 to January,2016 was done. There are 41 males and 39 females, age ranging from 1-78 years, and the mean age is 43.88 ± 14.54 years. The interval between occurrence of clinical symptom and treatment is 4 days-12 years. All the patients underwent preoperative CT scans, among whom 25 patients underwent MRI examine, and the operation plan was formulated on the basis of imaging examination. All the patients were followed up, lasting from 2 months to 12 years. Analyze the symptoms, physical signs, operative approachs, pathology results and postoperation complications of each approach using x2 test in SPSS 17.0 to see if there were statistical differences.ResultsAmong the 80 cases of primary parapharyngeal tumors, the age group with highest morbidity is 51-60 years group, consisting of 17 cases, having the proportion of 21.25%. The symptoms of the most common are pharyngeal/cervical masses disccoverd by themselves (42 cases), paraesthesia pharynges(9 cases) and interdict feeling of swallowing(9 cases). The physical signs of the most common are touching of pharyngeal masses(40 cases), and upheaval or skewing of lateral wall of pharyngeal and tonsils(27 cases). Both have statistical differences. CT and MRI can show the size, location, domain of tumors, as well as their relationship with surrounding tissue well, which provides important basis for the formulating of operation plans.Pathology result:72 cases were diagnosed as benign tumors by postoperation pathology, having the proportion of 90.00%. There were 42 cases of neurinomas,14 cases of pleomorphic adenomas,3 cases of basal cell adenomas,3 cases of fibrous histiocytomas,3 cases of hemangiomas,2 cases of paragangliomas,2 cases of branchiogenous cysts,1 case of bronchogenic cyst,1 case of lipomyoma,1 case of granular cell myoblastoma.8 cases were diagnosed as malignant tumors, among which there were 1 case of low differentiated squamous cell carcinoma,1 case of adenocarcinoma,1 case of clear cell carcinoma with cartilaginous metaplasia,1 case of high differentiated liposarcoma,1 case of myxofibrosarcoma, 1case of pleomorphic adenoma with partial malignant myoepithelioma,1 case of fibrous histiocytoma(low level of malignant),1 case of enbryonal rhabdomyosarcoma. The occurrence rate of benign tumors is significantly higher than malignant tumors, having statistical difference (P＜0.001). In benign tumors, the occurrence rate of neurinomas is higher than the others, having statistical difference (P＜0.001).Operative approach:There were 43 cases using trans-cervical approach,4 cases using trans-partoid approach,20 cases using transoral approach(2 of which assisted by nasal endoscope),12 cases using mandibulotomy, and 1 case using extended sublabial incision in the operations.Prognosis:Postoperation complications appeared in 17 cases in this group. Cervical/facial swelling appeared in 3 cases, trachyphonia appeared in 3 cases, bucking appeared in 3 cases, facial paralysis appeared in 2 cases, tongue deviation appeared in 2 cases, difficulty swallowing appeared in 2case, temporary suffocation appeared in 1 case, Hornor syndrome in 2 cases. Incision drainage was performed in 1 case because of blood clot accumulated in operation cavity. The occurrence rate of postoperation complications using each operative approach has no statistical difference (P>0.05). The follow-up rate of patients is 88.75%, when the follow-up rate of benign tumors’cases is 88.89%, in which no relapse occurred, and the follow-up rate of malignant tumors’cases is 87.50%, in which 2 patients died as a result. The three-year survival rate of malignant group is 71.43%(5/7).Conclusions1. The primary parapharyngeal tumors are of low incidence, which appear mostly in middle-aged individuals, whose clinical syndromes vary much and set barriers for diagnosis. CT and MRI can be used to show the size, location, domain of tumors, as well as their relationship with surrounding tissue well, which provides important basis for the formulating of operation plans.2. The characters of the pathology of primary pharyngeal tumors are complicated and various, mostly benign tumors in them. Neurinomats and pleomorphic adenomas appear most in benign tumors. The prognosis of benign tumors are much better compared with malignant tumors.3. Operativly treatment is the mostly used method in the treatment of primary pharyngeal tumors. The trans-cervical approach, trans-partoid approach, transoral approach(2 of which assisted by nasal endoscope), mandibulotomy, and extended sublabial incision were used in this group of cases. Trans-cervical approach is still the primary approach of PPS operation, using which most tumors can be resected completely. Transoral approach assisted by endoscope has the benefits of less trauma, wider field of vision and less postoperation complications.4. The occurrence rate of postoperative complications of primary PPS tumors is relatively high, whose types are also multifarious. Elaborate preoperative evaluation of primary parapharyngeal space tumors, appropriate chosen of surgical approach, and reasonable application of surgeries such as ligation or embolization of external carotid artery and tracheotomy are helpful to reduce the occurrence rate of postoperative complications.