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[Diagnosis and surgical approach of parapharyngeal space neoplasms].

OBJECTIVE
To explore the diagnosis and reasonable surgical approach for parapharyngeal space neoplasms.


METHOD
From July 2004 to July 2009, a retrospective review of 45 patients with neoplasms of parapharyngeal space was performed. Fourty-five cases were examined by CT, some of them were examined by MRI or DSA. Several surgical approaches were selected. The transcervical approach was used in 35 cases, the transparotid approach was used in 5 cases, the transmandible approach was used in 2 cases, and the transparotid and temporal approach was used in 3 cases.


RESULT
Among 45 patients, 37 cases (82.22%) were benign and 8 cases (17.78%) were malignant. Neurogenic neoplasms and salivary glands neoplasms were the most common tumors. Using CT, MRI or DSA could obtain useful information about the location, size, shape, density and degree of enhancement of the parapharyngeal space neoplasms, acquire their relationship with styloid and carotid, and make preoperative diagnosis. The diagnostic coincidence rate between preoperative diagnosis and pathological diagnosis was 80% (origin of tissue). All benign tumors were completely resected. A lymphangiomas had recurrence after 1 year,and the second operation had no recurrence. In the 45 cases, 8 cases were malignant tumors. Of 2 patients with malignant mixed tumors, 1 survived disease free after a follow-up of 4 years,and another was still alive with disease after a follow-up of 3 years; Of 2 patients with synovial sarcomas, 1 survived disease free for a follow-up of 3 years, the other one survived disease free after a follow-up of 2 years; 1 patient of nasopharyngeal carcinoma with metastasis in the parapharyngeal space had post-operative radical radiotherapy and survived disease free after a follow-up of 5 years. One patient with chordoma was still alive with disease after a follow-up of 3 years; 1 patient with poorly differentiated squamous cell carcinoma, died of pulmonary metastasis after a 4 year follow-up; 1 case with follicular dendritic cell sarcoma survived disease free after a follow-up of 2 years.


CONCLUSION
CT, MRI and DSA are essential for the diagnosis and differentiation of parapharyngeal space neoplasm. The transcervical approach is a simple, safe and minimal invasive procedure for resecting parapharyngeal space neoplasms. It is the best approach for treatment of parapharyngeal space neoplasms.