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Surgical treatment results of parapharyngeal space tumors: a report of 22 cases

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Rzepakowska A., Osuch-Wójcikiewicz E., Krupa Z., Durmaj A., Niemczyk K.
Otolaryngologia Polska
|
2018
|
vol. 72(4)
9-16
EN
Introduction: Parapharyngeal space (PPS) is the anatomical area lateral to the upper pharynx and clinically important due to PPS tumors. They account for less than 1% of head and neck neoplasms. Both benign and malignant neoplasms may arise there and typical for this localization is diversity of histological origin. Complete surgical excision is still the basis of treatment. Aim of the study: Evaluation of the results of surgical treatment of PPS tumors in the Department of Otolaryngology at the Medical University over the period 2015–2017. Material and methods: A retrospective analysis of medical records including complaints, physical examination, results of imaging studies, surgical approach, postoperative complication and histopathological results in 22 patients with a diagnosis of a PPS tumors. Results: The most frequent complaints reported by the patients were: discomfort in the throat, dysphagia, hearing disorders and a palpable tumor on the neck. Asymptomatic course of the disease was demonstrated in 4 cases. All patients were treated surgically: 2 with transoral approach, 9 with transparotid-transcervical approach, 11 with transcervical approach. In most cases the tumor was removed radically. In 2 patients intracapsular tumor resection was performed. Based on histopathological examination the benign lesions dominated (18/22). In 4 cases malignant neoplasms were diagnosed: carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and two cases of squamous cell carcinoma. The most common origin of PPS tumors was deep lobe of parotid gland and for this group 11 patients had diagnosis of pleomorphic adenoma. Other diagnosis included: paraganglioma, neurofibroma, hemangioma, lymphangioma and rhabdomyoma. Postoperative complications occurred in 9 patients and presented as hoarseness and dysphagia due to paresis of the lower group of cranial nerves (IX, X, XII). Significant intraoperative bleeding during surgery occurred in 2 cases and ligation of the external carotid artery was necessary. Conclusion: Due to the anatomical topography of PPS and its content with the essential vessels and the lower group of cranial nerves, the surgical treatment of pathology of this area is still a challenge for head and neck surgeons. The decrease of voice quality and impaired speech and swallowing should always be considered as complications post the surgical resection in PPS.
2
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Surgical treatment results of parapharyngeal space tumors: a report of 22 cases

100%
Rzepakowska A., Osuch-Wójcikiewicz E., Krupa Z., Durmaj A., Niemczyk K.
Polish Journal of Otolaryngology
|
2018
|
vol. 72
|
issue 4
9-16
EN
Introduction: Parapharyngeal space (PPS) is the anatomical area lateral to the upper pharynx and clinically important due to PPS tumors. They account for less than 1% of head and neck neoplasms. Both benign and malignant neoplasms may arise there and typical for this localization is diversity of histological origin. Complete surgical excision is still the basis of treatment. Aim of the study: Evaluation of the results of surgical treatment of PPS tumors in the Department of Otolaryngology at the Medical University over the period 2015–2017. Material and methods: A retrospective analysis of medical records including complaints, physical examination, results of imaging studies, surgical approach, postoperative complication and histopathological results in 22 patients with a diagnosis of a PPS tumors. Results: The most frequent complaints reported by the patients were: discomfort in the throat, dysphagia, hearing disorders and a palpable tumor on the neck. Asymptomatic course of the disease was demonstrated in 4 cases. All patients were treated surgically: 2 with transoral approach, 9 with transparotid-transcervical approach, 11 with transcervical approach. In most cases the tumor was removed radically. In 2 patients intracapsular tumor resection was performed. Based on histopathological examination the benign lesions dominated (18/22). In 4 cases malignant neoplasms were diagnosed: carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and two cases of squamous cell carcinoma. The most common origin of PPS tumors was deep lobe of parotid gland and for this group 11 patients had diagnosis of pleomorphic adenoma. Other diagnosis included: paraganglioma, neurofibroma, hemangioma, lymphangioma and rhabdomyoma. Postoperative complications occurred in 9 patients and presented as hoarseness and dysphagia due to paresis of the lower group of cranial nerves (IX, X, XII). Significant intraoperative bleeding during surgery occurred in 2 cases and ligation of the external carotid artery was necessary. Conclusion: Due to the anatomical topography of PPS and its content with the essential vessels and the lower group of cranial nerves, the surgical treatment of pathology of this area is still a challenge for head and neck surgeons. The decrease of voice quality and impaired speech and swallowing should always be considered as complications post the surgical resection in PPS.
3
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Schwannoma of the vagal nerve – case report

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Krawczyk P. H., Kaczmarczyk D., Braun M.
Polski Przegląd Otorynolaryngologiczny
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2017
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vol. 6(3)
19-24
EN
Schwann cell tumour is a rare benign neoplasms, which in approximately 25–45% of cases localises in the head and neck region. The half of them is found intracranially, within the cochleovestibular nerve (n. VIII) leading to deef. The slow growth and the lack of characteristic clinical signs influence clinically silent development of the tumour. Presence of the clinical signs may by connected with the pressure on the surrounding anatomical structures or the damage of the affected nerve. The treatment of the choice of the extracranial tumours is surgical resection. In presented case, the tumour development was signless. The attempt of the tumour enucleation was taken. Because of the difficulties with the tumour extracapsular enucleation, the decision of radical resection of the tumour and a part of the vagal nerve had been made. The vagal Schwann cell tumour is benign and rare neoplasm, that should be resected, despite it doesn’t influence the suspected patients survival. The main problem stands for the complications due to the nerve damaging during the surgery.
4
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Multiple paragangliomas of the head and neck - a case report

100%
Wojciechowski T., Drożdż A., Niemczyk K.
Polski Przegląd Otorynolaryngologiczny
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2018
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vol. 7(2)
60-66
EN
Paragangliomas are rare, most commonly non-malignant tumors of the autonomic nervous system. Their location within the head is rather an exception than a rule, similarly as their multifocal prevalence. The authors of this paper present a case of a patient with bi-focal paraganglioma. The first symptom of illness was facial nerve palsy, diagnosed for the period of about 3 years. After making the initial diagnosis of tympanic paraganglioma, the tumor was operated. During the next 7 years, there was a recurrence within the temporal bone. What is more, periodic imaging examination showed second foci within the neck, moreover asymptomatic. The authors discuss the natural development of paragangliomas in the region of head and neck and present the current knowledge about management of patients with a suspicion, diagnosis, and treatment of this disease.
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