Bozza F, Vigili M G, Ruscito P, Marzetti A, Marzetti F
Department of Maxillo-Facial Surgery, San Filippo Neri Hospital, Rome, Italy.
Acta Otorhinolaryngol Ital. 2009 Feb;29(1):10-5.
Although primary tumours of the parapharyngeal space are rare and account for only 0.5% of head and neck neoplasms, they represent a formidable challenge to the surgeon both in the assessment of the preoperative condition and the appropriate surgical approach. This study is a retrospective review of the clinical records of 12 patients (8 male, 4 female, mean age 49 years), treated for parapharyngeal space tumours by the same surgical team from 1992 to 1998 and observed at follow-up for at least 10 years. Of these, 8 (66.6%) were benign and 4 (33.4%) malignant. Magnetic resonance imaging and fine-needle aspiration biopsy were performed as the preoperative evaluation in 8/12 cases. The positive predictive value of our fine-needle aspiration biopsy was 75% for benign tumours (3/4) and 100% (4/4) for malignant tumours. Different surgical approaches were used: transcervical-transmandibular in 5 cases (41.6%); transparotid-transcervical in 4 patients (33.4%); transoral in 2 patients (16.6%) with a small pleomorphic adenoma of the deep lobe of parotid, and in the last case (8.4%), transcervical surgery was performed for papillary thyroid carcinoma metastasis. Post-operative complications occurred in 3/12 patients: two developed Horner's syndrome and one patient presented a temporary marginal mandibular of facial nerve dysfunction. Post-operative radiotherapy was performed in 3/4 patients on account of malignancy. Each patient underwent a follow-up protocol of clinical controls and ultrasonography every 6 months, computed tomography and/or magnetic resonance imaging once a year for 10 years. Eleven patients (91.4%) were still disease free after 10-year follow-up. One patient with a recurrent parotid gland adenocarcinoma died of distant metastasis 4 years after parapharyngeal space surgery. These 12 parapharyngeal space tumours were treated with use of one of the various surgical approaches described in relation to the histopathological diagnosis (benign or malignant), to the side (prestyloid or poststyloid) and to the size (+/-4 cm) of the neoplasia and, moreover, were observed at long-term follow-up. Results of personal experience in the treatment of the tumours of the parapharyngeal space confirm the necessity to follow a careful preoperative diagnostic outline that must be taken advantage of the study for imaging (computed tomography, magnetic resonance imaging) and of cytology, in order to plan surgical treatment with a safe approach and that reduces complications, aesthetic-functional damages and risk of recurrence.
尽管咽旁间隙原发性肿瘤罕见，仅占头颈部肿瘤的0.5%，但无论在术前病情评估还是选择合适的手术入路方面，都给外科医生带来了巨大挑战。本研究回顾性分析了1992年至1998年由同一手术团队治疗的12例咽旁间隙肿瘤患者（8例男性，4例女性，平均年龄49岁）的临床记录，并进行了至少10年的随访观察。其中，8例（66.6%）为良性肿瘤，4例（33.4%）为恶性肿瘤。12例中有8例在术前评估时进行了磁共振成像和细针穿刺活检。我们的细针穿刺活检对良性肿瘤的阳性预测值为75%（3/4），对恶性肿瘤为100%（4/4）。采用了不同的手术入路：5例（41.6%）采用经颈-经下颌入路；4例（33.4%）采用经腮腺-经颈入路；2例（16.6%）因腮腺深叶小多形性腺瘤采用经口入路，最后1例（8.4%）因乳头状甲状腺癌转移采用经颈手术。12例患者中有3例出现术后并发症：2例出现霍纳综合征，1例出现面神经下颌缘支暂时性功能障碍。4例恶性肿瘤患者中有3例接受了术后放疗。每位患者每6个月接受一次临床检查和超声检查，每年接受一次计算机断层扫描和/或磁共振成像检查，持续10年。10年随访后，11例患者（91.4%）仍无疾病复发。1例复发性腮腺腺癌患者在咽旁间隙手术后4年死于远处转移。这12例咽旁间隙肿瘤根据组织病理学诊断（良性或恶性）、肿瘤所在侧（茎突前或茎突后）以及肿瘤大小（±4 cm），采用了上述各种手术入路之一进行治疗，并且进行了长期随访观察。个人治疗咽旁间隙肿瘤的经验结果证实，有必要遵循仔细的术前诊断方案，充分利用影像学检查（计算机断层扫描、磁共振成像）和细胞学检查，以便以安全的手术入路进行手术治疗，减少并发症、美观功能损害和复发风险。
