Peng Hwa Tiffany, Cheng Michael, Sadoughi Babak
Department of Otolaryngology-Head and Neck Surgery, The Sean Parker Institute for the Voice, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York, USA.
Biomed Hub. 2020 Oct 20;5(3):376-384. doi: 10.1159/000511133. eCollection 2020 Sep-Dec.
Branchial anomalies can present in the parapharyngeal space, creating unique challenges in management. Historically, this approach warranted an open approach, including transcervical, transparotid with total parotidectomy and retromandibular dissection, or transmandibular dissection with mandibulotomy. However, the advent of minimally invasive transoral techniques and laser resection have allowed for successful resection of masses in this anatomical region without an external approach. We illustrate these advancements with the case of a 30-year-old man with globus sensation and throat discomfort, found to have a mass of the right posterolateral oropharynx causing severe airway obstruction. Imaging showed a parapharyngeal mass with extension to the carotid sheath and retropharyngeal space, which was successfully resected with potassium-titanyl-phosphate (KTP) laser using a minimally invasive transoral approach with no major complications. Transoral excision offers decreased morbidity and a cosmetically favorable outcome compared to transcervical excision. KTP laser may be safely used for transoral excision of a benign parapharyngeal mass.
鳃裂畸形可出现在咽旁间隙，给治疗带来独特挑战。从历史上看，这种情况需要采用开放手术方法，包括经颈入路、经腮腺全切除术及下颌后间隙解剖的经腮腺入路，或行下颌骨切开术的经下颌入路。然而，微创经口技术和激光切除术的出现，使得在不采用外部入路的情况下成功切除该解剖区域的肿物成为可能。我们通过一例30岁男性病例来说明这些进展，该患者有咽部异物感和咽喉不适，发现右侧口咽后外侧有一肿物导致严重气道阻塞。影像学检查显示咽旁肿物延伸至颈动脉鞘和咽后间隙，采用微创经口入路使用磷酸钛钾（KTP）激光成功切除，无重大并发症。与经颈切除相比，经口切除的发病率更低，美容效果更佳。KTP激光可安全用于经口切除良性咽旁肿物。
