What is a parapharyngeal neoplasm?
Parapharyngeal space (PPS) neoplasms are a rare subset of head and neck tumors. The majority of PPS neoplasms are benign, but a wide variety of pathologies, both benign and malignant have been reported. This range of histopathologies in combination with the complex anatomy of the PPS creates complex diagnostic and management challenges. The PPS represents a complex anatomic region that presents the head and neck surgeon with a wide range of disease pathologies.
What should you know about parapharyngeal neoplasms?
Patients most often present with a neck mass. Preoperative imaging may include CT and MRI. CT is more common. Fine-needle aspiration biopsy of the neck mass is beneficial. The majority of tumors are benign, with pleomorphic adenomas comprising the majority. Malignant rumors can occur, with adenocarcinomas being the most common. All patients should undergo primary surgical management ± adjuvant therapy. The cervical-parotid approach is the most common approach. A mandibulotomy may be required in just some cases. Post-operative cranial neuropathies are identified in about 20% of patients. Of these, 50% are sequelae from resection of neurogenic tumors. Perioperative mortality is rare. Patients should continue to follow-up to assess for recurrence. 5-/10-/20-year recurrence free survival is generally > 90%/80%/70% for benign and 40%/30%/20% for malignant lesions. 5-/10-/20-year disease specific survival are generally > 90%/90%/90% for benign and 50% /40%/20% for malignant lesions. 5-/10-/20-year overall survival are generally > 90%/80% /70% for benign and 40%/30%/10% for malignant lesions.
Take home message:
While the rate of recurrence for benign parapharyngeal space lesions is low. Patients remain at risk for recurrence>20 years following surgery. Long-term surveillance should be considered and pursured. Patients with malignant lesions are at higher risk for recurrence and have a poor oncologic prognosis. The cervical-parotid approach remains safe and effective for most PPS neoplasms.
The management of parapharyngeal disease can be complex. If you have any questions regarding this or other area of ear, nose, throat, head and neck cancer, sleep surgery, thyroid and parathyroid, please do not hesitate to call. ENT is trained in 7 core areas over a 5 year residency after medical school: allergy, facial plastic and reconstructive surgery, head and neck, laryngology, otology, pediatric otolaryngology, and rhinology. We are the only surgical specialty dedicated solely to this area.
Philip Harris, M.D. FACS
MidMichigan Physicians Group
Midland / Gladwin / Bay City
Phone (989) 839-6201