Transoral Endoscopic/Microscopic Surgery for Tumor Resection in the Retrostyloid Parapharyngeal Space Via the Pterygomandibular Ligament Approach: A Retrospective Analysis of 21 Cases at a Single Center

Objective: This article aims to investigate the safety and efficacy of transoral endoscopic/microscopic resection of tumors in the retrostyloid parapharyngeal space via the pterygomandibular ligament approach.

Methods: A retrospective analysis was conducted on cases of transoral endoscopic/microscopic resection of tumors in the retrostyloid parapharyngeal space from December 2012 to May 2024. The effectiveness of this approach and perioperative complications were evaluated. Perioperative information such as blood loss, major nerve damage, complete tumor resection, postoperative wound healing, soft palate movement, and lip numbness were recorded. Incision design: A longitudinal incision on the pharyngeal side was made, starting from the inner side of the gingiva of the second to third maxillary molars, 0.5 cm from the gingival margin, lateral to the greater and lesser palatine foramina, closely adhering to the inner side of the pterygomandibular ligament, extending down to the lateral edge of the palatoglossal arch. The incision length was about 5 to 6 cm, adjusted flexibly according to the tumor location.

Results: A total of 21 patients were included, with 9 males and 12 females; 9 cases had tumors extending to the jugular foramen area; all tumors were pathologically diagnosed as schwannomas; 7 cases underwent en bloc resection, and 14 cases underwent piecemeal resection; the average maximum tumor diameter was 4.5 cm; the average operation time was 4 hours and 48 minutes; the average intraoperative blood loss was 124.3 mL; the average follow-up period was 19.3 months; postoperative complications included Horner’s syndrome in 2 cases, transient hoarseness in 4 cases, cerebrospinal fluid leakage in 2 cases, and numbness in the incision area in 1 case, with all except Horner’s syndrome recovering after symptomatic treatment.

Conclusion: The transoral endoscopic/microscopic approach via the pterygomandibular ligament provides sufficient exposure of the retrostyloid parapharyngeal space anatomical structures and allows for safe and effective resection of tumors in the retrostyloid parapharyngeal space.

Publication History

Article published online:
07 February 2025