The Analysis Of Diagnosis And Treatment Of Space-occupying Lesions In The Parapharyngeal Space

Objective:To learn the anatomical features of the parapharyngeal space and its relationship with the parapharyngeal space occupying lesions,to analysis the clinical features of the parapharyngeal space occupying lesions,imaging features,surgical approach and methods to reduce various complications.MethodRetrospective analysis the clinical data of 169 patients with parapharyngeal space-occupying lesions admitted to the Department of Head and Neck Surgery,Shandong University from November 2008 to November 2018.There were 100 males and 69 females in this study.The age of onset was 15-86 years old and the median age was 45 years old.The most common first symptom in patients was pharyngeal discomfort and/or eating obstruction(92 cases,54%),followed by neck(35 cases,21%)or oropharynx(28 cases,17%)lumps.Other symptoms including pain,fever,unclear speech,and limited mouth opening were 42 cases(25%).It should be noted that 22 patients(13%)accidentally found a space-occupying lesion in the absence of subjective symptoms.The most common physical examination was the discovery of the posterior wall of the oropharynx(side wall)and/or the tonsil bulge,a total of 104 cases(62%),followed by a neck mass,43 cases(25%).There were 7 patients(4%)with no significant positive results on physical examination.CT and MR examinations are the most common imaging examinations.In this study,148 patients(92%)underwent CT examination and 67 patients(40%)underwent MR examination.Suspected angiogenic tumors,paraganglioma,preoperative CTA/MRA/DSA examination in 17 patients(10%).Other auxiliary examinations included 25 cases of electronic nasopharyngoscopy,10 cases of B-ultrasound,and 12 cases of fine needle aspiration biopsy(outside the hospital).All patients underwent standard surgical procedures,including 164 cases of Transcervical approach(97%,)and 5 cases(3%)of Transoral approach?A total of 147 cases(87%)of benign and malignant tumors were included,of which 139 cases(82.3%)were completely resected,and the remaining 8 cases(4.7%)were confirmed by biopsy and then transferred to the oncology department for further treatment.ResultsAccording to the pathological diagnosis,146 cases(88.2%)of benign lesions,20 cases(11.8%)of malignant lesions,78 cases(46.2%)of myoschwannoma were the most common pathological type,followed by pleomorphic adenomas 22(13%)example.CT,MRI and other auxiliary examinations were performed before operation to clearly show the location,size and degree of invasion of the parapharyngeal space.The surgical approach based on the external approach was adopted,in which 139 cases were completely resected,and the remaining 8 cases(4.7%)were confirmed by biopsy and then transferred to the oncology department for further treatment.There were 22 cases(13%)with parapharyngeal space infection and abscess formation.Except one case was due to late treatment,severe sepsis occurred,and ICU was transferred to the ICU.The rest were treated with abscess incision and drainage.After comprehensive treatment,he was discharged from hospital.24 cases of postoperative complications.Nerve injury was common,7 cases of hoarseness,including 3 cases of transient facial paralysis,after symptomatic treatment improved;5 cases of tongue deviation;5 cases of Horner syndrome,symptoms improved after half a month,facial 2 cases of swelling.In all cases,no wound bleeding or infection occurred after surgery.13 patients were lost to follow-up,and the follow-up rate was 81.6%.No recurrence was found after surgical treatment of benign tumor patients.Three patients with malignant tumors were followed up for recurrence(1 case of malignant chordoma,1 case of invasive neurofibromatosis,1 case of malignant schwannomas).All patients with recurrence underwent reoperation and adjuvant radiotherapy and chemotherapy.conclusionsThe incidence of parapharyngeal space lesions is low,and due to its special anatomical location,most cases are usually asymptomatic early.When performing routine physical examination or finding a lump in the pharyngeal wall or neck,or patients with unexplained symptoms such as open mouth and tinnitus,CT,MRI and other imaging examinations should be performed to help detect the tumor early and avoid Misdiagnosis,missed diagnosis,and improve the early diagnosis rate of parapharyngeal space tumors.Surgery for parapharyngeal space tumors requires significant exposure and careful handling to avoid complications because of its deep location and important neurological and vascular structures.Combined with this group of studies and domestic and foreign literature reports,the external approach of the neck can meet the majority of surgical needs.The postoperative complications of parapharyngeal tumors are mainly due to the posterior cranial nerve injury that occurs when the neurogenic tumor or malignant tumor is removed.The surgeon should be familiar with the anatomical structure of the parapharyngeal space.The preoperative preparation can be adequately performed,the operation is carefully performed,and the appropriate postoperative treatment is performed smoothly,so that the tumor can be completely removed as much as possible to reduce the occurrence of postoperative complications.