Minimally invasive management of parapharyngeal space tumors: Introducing a decision-making algorithm and radiologic tool

Objective: Traditionally tumors of the parapharyngeal space (PPS) are resected through transcervical approaches. More recent approaches include endoscopic approaches or trans oral robotic surgery (TORS) without directions when to use which approach. Our objective was to find objective parameters to choose the most suitable approach.

Methods: It is a retrospective study containing 6 patients from May 2019 to May 2021 with tumors of the PPS in the Department of Otolaryngology and Head Neck Surgery at the Hospital of Lucerne, Switzelrand

Results: The data was analysed in average 53 months after surgery. Tumor resection was completed with TORS in 3 patients, endoscopical in 3 patients. Mean operation time was 114 min (51 min-178 min). No major complications occurred. No evidence of tumor was found in magnetic resonance imaging studies postoperatively in all patients.

Conclusion: We conclude that a resection via TORS or endoscopical technique is safe and effective. Furthermore, we postulate that the further a tumor is located in the upper lateral area of the PPS, an approach via TORS is not possible.