Psychogios Georgios V, Michali Maria C, Litsou Eleni V, Komnos Ioannis D, Basiari Lentiona V
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Ioannina, Ioannina, GRC.
Cureus. 2023 May 30;15(5):e39700. doi: 10.7759/cureus.39700. eCollection 2023 May.
Primary parapharyngeal space tumors are rare, and due to the complex anatomy of the parapharyngeal space, their diagnosis and treatment are challenging. Pleomorphic adenoma is the most common histologic type followed by paragangliomas and neurogenic tumors. They can present as a neck lump or an intraoral submucosal mass with the displacement of the ipsilateral tonsil or might be asymptomatic and discovered incidentally on imaging obtained for other reasons. Magnetic resonance imaging (MRI) with gadolinium is the imaging of choice. Surgery remains the treatment of choice and many approaches have been described. In this study, we present three patients with PPS pleomorphic adenoma (two primary and one recurrent), which were resected successfully with a transcervical-transparotid approach without mandibulotomy. Division of the following anatomical structures: the posterior belly of the digastric muscle, stylomandibular ligament, stylohyoid muscle and ligament, and styloglossus muscle is a very important tip for the surgeons because enables displacement of the mandible providing excellent exposure for complete tumor excision. The only postoperative complication was temporary facial nerve palsy in two patients who fully recovered within two months. The aim of this mini case series is to present our experience, together with some tips and benefits of the transcervical-transparotid approach for the resection of pleomorphic adenomas of the PPS.
原发性咽旁间隙肿瘤较为罕见，由于咽旁间隙解剖结构复杂，其诊断和治疗颇具挑战性。多形性腺瘤是最常见的组织学类型，其次是副神经节瘤和神经源性肿瘤。它们可表现为颈部肿块或同侧扁桃体移位的口内黏膜下肿物，也可能无症状，在因其他原因进行的影像学检查中偶然发现。钆增强磁共振成像（MRI）是首选的影像学检查方法。手术仍然是首选的治疗方式，已有多种手术入路被描述。在本研究中，我们展示了3例咽旁间隙多形性腺瘤患者（2例原发性和1例复发性），采用经颈 - 腮腺入路成功切除，未行下颌骨切开术。对于外科医生来说，分离以下解剖结构：二腹肌后腹、茎突下颌韧带、茎突舌骨肌和韧带以及茎突舌肌是非常重要的技巧，因为这能使下颌骨移位，为完整切除肿瘤提供良好的视野。仅2例患者出现术后暂时性面神经麻痹，均在2个月内完全恢复。本小型病例系列的目的是介绍我们的经验，以及经颈 - 腮腺入路切除咽旁间隙多形性腺瘤的一些技巧和优势。
