Surgical approaches to the parapharyngeal and retropharyngeal space include transoral and transcervical. A 47yearold female presented with a 2 cm conventional papillary thyroid cancer in the right thyroid lobe with central right lateral neck metastases, as well as a 2. Salivary gland neoplasms benign to malignant ratio 3. Contrastenhanced ct scan revealed a large mass located in the right parapharyngeal space, causing medialisation of the pharyngeal wall. The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. The book aims to promote exchanges of ideas between practitioners and institutions in the developing world, to promote appropriate.
The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig. Parapharyngeal space pps tumors are very rare, representing about 0. It is divided into prestyloid and poststyloid compartments, separated by the tensor veli palatini muscle and styloid process 1, 2. A thyroid tumor extending to the parapharyngeal space. The usefulness of this classification in helping the surgeon to decide which surgical approach is the most suitable for a particular lesion is discussed. Pdf background tumors of the parapharyngeal space pps are rare, accounting for 0. May 17, 20 the parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck. A axial section through the oral pharynx demonstrating the contents of the parapharyngeal space. The parapharyngeal space is a deeply situated space on either side of head. A dislocated lateral pharyngeal wall with mild inflammatory changes of the oropharyngeal mucosa was observed during. Burkitts lymphoma of the parapharyngeal space jama.
The parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. Inflammatory pseudotumors in the parapharyngeal space are rare, and only three cases. The roof of the parapharyngeal space pps is poorly defined. It is an inverted coneshaped potential space that extends from the hyoid bone to the base of the skull. Pdf the transcervical approach for parapharyngeal space. To describe the imaging features of a variety of disease processes that may occur in the pps. The parapharyngeal space pps is located in the suprahyoid neck between the hyoid bone and the skull base, alongside the pharynx. Behind both the parapharyngeal space and carotid space lies the retropharyngeal space, and deep to this a potential space known as the danger.
Some investigators have reported pleo morphic adenomas originating in the deep lobe of the. Most are benign and represent a wide range of tumor growth, from parotid extension to intrinsic growth of nerves, blood vessels, and salivary gland tissues within or around the parapharyngeal area. Unusual mr and ct findings of an inflammatory pseudotumor in the parapharyngeal space of a 73yearold woman are reported. Tumors of the parapharyngeal space jama otolaryngologyhead. These lesions could be classified as being either hypervascular glomus tumors or metastatic kidney, thyroid, or venous hemangiomas or hypovascular salivary gland tumors, neurogenic tumors, lymphomas. Anatomy and common pathology of the parapharyngeal space. Unusual ct and mr findings of inflammatory pseudotumor in the. Most pps tumors are of salivary or neurogenic origin. However in actuality these spaces are all connected and anatomic. The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and. Management of parapharyngeal and retropharyngeal space infections. It is even more uncommon for this nonendemic form of the disease to present in the head and neck region. The lesion caused loss of the fat plane between the parapharyngeal space and masticator space with subsequent inflammation of the pterygoid space.
The vagus nerve is reported to be the origin for 50 % of parapharyngeal space schwannomas, and the cervical sympathetic chain is the. Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. April 08, 2020 the fascial spaces are theoretical spaces that are created between the layers of the deep cervical fascia and are filled with loose areolar connective tissue. To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. Of the 44 patients with pa, 35 patients underwent 38 excisions.
Lateral and inferior to the parapharyngeal space is the carotid sheath, containing the internal carotid artery and cranial nerves ix, x and xi. The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal. Sep 05, 2019 tumors of the parapharyngeal space pps, a potential space lateral to the upper pharynx, are uncommon, comprising less than 1% of all head and neck neoplasms. The parapharyngeal space pps is a space in the suprahyoid neck that contains fat and is surrounded by several other spaces defined by the fascial layers of the neck. Background the pps is defined as the deepest space in the neck and it consists of the pre. Imaging of parapharyngeal space lesions focus on the prestyloid compartment ji hoon shin 1, ho kyu lee 1, sang yoon kim 2, choong gon choi 1 and dae chul suh 1. Tumors of the parapharyngeal space pps are rare, accounting for 0. Due to the complex anatomy of this region, they are often managed by head and neck surgeons. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. The schwannoma is the most common neural tumor found in the pps.
Introduction less then 1% of head and neck neoplasms 7080% are benign radiological imaging very important for diagnosis surgical excision is the primary treatment morbidity of surgery should be considered along with natural history of disease in making a treatment plan. Parapharyngeal masses can represent a relevant differential diagnostic challenge for clinicians because of the variety of pathological entities that arise in the parapharyngeal space, and the anatomical and functional complexity of the region. The parapharyngeal space pps is a complex anatomic space that is commonly described as an inverted pyramid, with the temporal bone located at the base and the hyoid bone at the apex. The prestyloid space contains the deep lobe of the parotid, fat, and lymph nodes. Transoral robotic surgery in retrostyloid parapharyngeal space schwannomas. The international federation of head and neck oncologic societiescurrent concepts in head and neck surgery and oncology 2012 parapharyngeal space tumors jatin p. Parapharyngeal space tumors account for less than 1% of all head and neck neoplasms. The differential for parapharyngeal space masses is extensive and can be roughly.
Excision of tumors in the parapharyngeal space using an. To illustrate the radiological anatomy of the parapharyngeal space pps. The parapharyngeal space is a complex anatomic area with a wide array of potential pathologies. The parapharyngeal space blue is defined superiorly by the skull base, inferiorly by the hyoid bone. Unusual ct and mr findings of inflammatory pseudotumor in. Furthermore, a clinical division of the parapharyngeal space in the superiorinferior axis is established. Parapharyngeal space an overview sciencedirect topics. Parapharyngeal space spatium parapharyngeum is space lateral and dorsolateral to pharynx, medially continues into retropharyngeal space boundaries. Parapharyngeal space nodal metastases are usually secondary to malignancies of the pharynx and sinonasal tract, although localization of lymphomas is also possible. The parapharyngeal space or lateral pharyngeal or pharyngomaxillary space is in the upper neck above the hyoid bone. Approximately 70% to 80% of tumors originating from the pps are benign. Pleomorphic adenoma in the parapharyngeal space joms.
Parapharyngeal space mass laryngology jama otolaryngology. Background head and neck parapharyngeal space tumors are rare. Pdf a thyroid tumor extending to the parapharyngeal space. To our knowledge, nonendemic burkitts lymphoma has not been previously reported arising. We retrospectively studied tumors of the parapharyngeal space treated at the baylor college of medicine affiliated hospital system, houston, from 1972 to 1985. Management of parapharyngeal and retropharyngeal space. No lymph node involvement was detected by ct or mri. Approximately 50% of the tumours have a salivary origin, 20% are neurogenic and the remaining 30% are represented by tumours such as benign and malignant lymphoreticular lesions, metastatic lesions and carotid body tumours. The parapharyngeal space is a potential space occupied by adipose tissue, cranial nerves v, ix, xi, and xii, the deep cervical lymph nodes, and the ascending pharyngeal and maxillary arteries. Tumors of the parapharyngeal space jama otolaryngology. Parapharyngeal abscess merck manuals professional edition. Of all the parapharyngeal space tumors, 7080 % are benign, and 2030 % are malignant.
The mass was hypointense on t1 and t2weighted images and demonstrated ring enhancement after contrast medium injection. Parapharyngeal space pps tumours are very rare and account for only 0. Eighty percent of the parapharyngeal space neoplasms were benign. Approaches to the diagnosis and treatment of tumors of the. Diagnosis and treatment considerations of parapharyngeal. The hyoid bone is the main anatomical structure that limits the spread of infection. Both benign and malignant tumors may arise from any of the structures contained within the parapharyngeal space pps. Synonyms for parapharyngeal space in free thesaurus. Parapharyngeal definition of parapharyngeal by medical. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. Clinical assessment of lesions in this space in very difficult.
The medial and lateral pterygoid plates were removed. Parapharyngeal space synonyms, parapharyngeal space. The transcervical approach for parapharyngeal space pleomorphic. Tumors of the parapharyngeal space appear as painless masses bulging into the tonsillar, nasopharyngeal, or retromandibular area. The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. Parapharyngeal abscess msd manual professional edition. The parapharyngeal space surrounds the pharynx and harbors 0. Tumours of the parapharyngeal space are rare, accounting for less than 1 % of all head and neck neoplasms. A rare case of large schwannoma of the parapharyngeal space. Tumors of parapharyngeal space iowa head and neck protocols.
Mri demonstrating the parapharyngeal space blue and the retropharyngeal space red. Parapharyngeal space is divided by styloid septum, which runs from stylohyoid lig. It consists largely of fat, neurovascular structures, and, in some definitions. Infections of the parapharyngeal space jama otolaryngology. Pps masses are rare, accounting for approximately 0. The transcervical approach for parapharyngeal space pleomorphic adenomas.
This article presents the spatial anatomy of the pps and describes the displacement patterns of the pps fat that are essential for accurate diagnosis and appropriate treatment of. Symptoms include fever, sore throat, odynophagia, and swelling in the neck down to the hyoid bone. In order to study the anatomy of this space three horizontal sections through the skull are used, as pointed out in figure 1. Parapharyngeal space tumors are rare and account for 0. The pharyngeal mucosa of the left lateral pharyngeal wall was effaced owing to mass effect figure. Article information, pdf download for roof of the parapharyngeal space. To our knowledge, nonendemic burkitts lymphoma has not been previously reported arising from the parapharyngeal space. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. Infections in the parapharyngeal space usually originate in the tonsils or pharynx, although local spread from odontogenic sources and.
To allow better visualization and increased triangulation of a bimanual dissection technique, a sublabial canine fossa antrostomy was created. Parapharyngeal dissection for papillary thyroid cancer. The pharyngeal mucosa of the left lateral pharyngeal wall was effaced owing to mass effect figure, a. It consists largely of fat, neurovascular structures, and, in some definitions, the retromandibular part of the deep lobe of the parotid gland. These lesions could be classified as being either hypervascular glomus tumors or metastatic kidney, thyroid, or venous hemangiomas or hypovascular salivary gland tumors, neurogenic tumors, lymphomas, sarcomas. Punctated calcifications were scattered at the periphery.
Tumors in the parapharyngeal space pps are uncommon, 1 4 accounting for only 0. They are difficult to diagnose because they have few symptoms and are. Anatomy at the level of the oropharynx and the nasopharynx a small space, called the parapharyngeal space or the pharyngomaxillary space, borders on the pharynx. The presence of tumors within the parapharyngeal space is rare. The parapharyngeal space is shaped like an inverted pyramid. Surgical management of parapharyngeal space infections. Diagnosis and treatment considerations of parapharyngeal space. Fiftyseven percent 3154 were of neurogenic origin, 30% 1654 were of salivary origin, and % 754. Developing world ent is important as more than 50% of the worlds people live in the developing world. Tumors of the parapharyngeal space pps, a potential space lateral to the upper pharynx, are uncommon, comprising less than 1% of all head and neck neoplasms. The usual anatomic division of the parapharyngeal space into prestyloid and poststyloid spaces does not help the clinician determine which approach to use for a specific tumor. The special traits of the presented case included the following. Contents 1 prestyloid part of parapharyngeal space.
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