J Neurol Surg B Skull Base 2020; 81(S 01): S1-S272
DOI: 10.1055/s-0040-1702637
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Transnasal Combined Transoral Approach for Giant Parapharyngeal Space Tumors

Xicai Sun
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Huan Wang
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Quan Liu
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Weidong Zhao
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Yurong Gu
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Houyong Li
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Chunquan Zheng
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Hongmeng Yu
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
,
Dehui Wang
1   Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
› Author Affiliations
Further Information

Publication History

Publication Date:
05 February 2020 (online)

 

Background: Surgical treatment of parapharyngeal space tumors is challenging. With the development of endoscopic skull base surgery, various endoscopic-assisted surgical approaches have become one of the options for parapharyngeal space surgery. The purpose of this study was to compare the anatomical characteristics of parapharyngeal space between endoscopic transnasal and transoral approaches, and to explore the application of endoscopic-assisted transnasal combined with transoral approach in giant parapharyngeal space occupying surgery.

Materials and Methods: Six fresh cadaveric heads (12 sides) perfused with silicon gel were dissected under endoscopy, and possible surgical anatomical markers were found. Three cases of giant parapharyngeal space lesions treated by endoscopic transnasal and transmaxillary sinus combined with transoral approach were reported.

Results: The anatomical details of parapharyngeal space could be displayed through both transnasal and transoral approaches. Transnasal and transmaxillary sinus approaches are more direct in exposing the parapharyngeal space, and have advantages in resecting tumors invading the skull base. But its exposure range is limited, the lower boundary is hard palate, the lateral boundary is medial pterygoid muscle and temporal muscle. The structure of the parapharyngeal space exposed directly through the transoral approach, but the exposure to the anatomical structure around the Eustachian tube was limited. The stylopharyngeal muscle and stylohyoid muscle can be used as the anatomical markers for locating the parapharyngeal internal carotid artery through the transoral approach. Endoscopic-assisted transnasal transmaxillary sinus and combined with transoral approach were used to complete the resection of three patients with giant parapharyngeal space tumors. No obvious complications occurred.

Conclusion: Endoscopic-assisted transnasal maxillary sinus and combined with transoral approach can be used for giant parapharyngeal space tumor surgery. This approach can clearly show the important neurovascular structures in the parapharyngeal space. Endoscopic-assisted transoral approach is more direct in exposing the parapharyngeal internal carotid artery.