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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
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2018
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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
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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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Synovial sarcoma of the parotid gland – case report

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Zagacki D., Niemczyk K., Bruzgielewicz A., Morawiec-Sztandera A., Braun M., Niedźwiecka I., Kubiak M., Kaczmarczyk D.
Polski Przegląd Otorynolaryngologiczny
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2018
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vol. 7(3)
1-5
EN
Salivary gland neoplasms represent about 3% of head and neck tumors. The area most affected by tumors is parotid salivary gland (standing for about 80% of all cases). The most common type of the neoplasm is pleomorphic adenoma (which accounts for 80-90% of all diagnoses). One of the rare diagnoses in this region comprises synovial sarcoma, as it mainly occurs in lower extremities. In head and neck region it accounts for about 3% of all diagnoses. About 20 cases have been described in this region, so far. The etiology of the disease remains unknown, but there are reports linking synovial sarcoma with the rearrangement in the gene responsible for chromosomal transcription t(X;18) (p11,q11).
4
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Hemangiopericytoma – a case report of a rare tumour of the parapharyngeal space

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Cybulska K., Jarosz M., Rzepakowska A., Niemczyk K.
Polski Przegląd Otorynolaryngologiczny
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2017
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vol. 6(2)
56-63
EN
Introduction: Hemangiopericytoma is a mesenchymal tumour originating from pericytes surrounding the capillary vessels. The etiology of this tumour is still unknown. It may be located in any part of the human body. The most common sites are pelvis and lower limbs and less often it occurs in the head and neck. The characteristic signs of hemangiopericytoma are slow growth regardless of the malignancy level and high vascularity. Surgical excision of the tumour with additional radiotherapy is the treatment of choice. Case report: A symptom presentation and diagnostic-therapeutic process in a 71-year-old woman admitted to the Department of Otolaryngology of the Medical University of Warsaw due to increasing bilateral nasal obstruction and dysphagia is herein described. Diagnostic imaging showed highly vascularized tumour in the parapharyngeal space also obstructing the left side of the nasopharynx. After evaluation, tumour resection from the external approach was planned and performed, followed by an uncomplicated postoperative course. Histopathological examination revealed hemangiopericytoma. The patient was qualified for adjuvant radiotherapy. She stays under observation with no signs of recurrence since surgery. Conclusions: Hemangiopericytoma is a rare tumour with a wide variety of clinical presentations and a relapse-free survival that is difficult to predict. Long-lasting asymptomatic tumour growth results in late diagnosis. Imaging and primarily, histopathological examination are fundamental for the diagnostic process. The best outcome is observed after radical surgical treatment. In order to reduce the risk of recurrence, additional radiotherapy is advised. Local recurrence may appear years after finished treatment, therefore long-term follow-up is essential.
5
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Rhabdomyoma of the Parapharyngeal Space – A Case Report

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Sieniawska-Buccella O., Osuch-Wójcikiewicz E., Kazimierska K., Kukawska M., Rzepakowska A., Niemczyk K.
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EN
Introduction: Rhabdomyomas (RM) are rare benign mesenchymal tumors. They are a much more uncommon entity than their malignant counterparts, rhabdomyosarcomas. Rhabdomyomas fall into two general categories: cardiac tumors and extracardiac tumors. Extracardiac myomas are among the rarest tumors in humans and can be classified as fetal and adult, depending on the degree of differentiation of individual tumors by light microscopy. Adult extracardiac myoma is most commonly characterized by the occurrence in the head and neck, and mainly in the laryngeal and pharyngeal area. Case report: This article presents a case of rhabdomyoma of the parapharyngeal space with a review of world literature.
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First bite syndrome: the complication to keep in mind

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Tretiakow D., Skorek A.
Polski Przegląd Otorynolaryngologiczny
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2019
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vol. 8(4)
1-3
EN
The First Bite Syndrome is a rare late (1-2 months) post operation complication of surgery in the infratemporal fossa, parapharyngeal space and especially involving the deep lobe of parotid gland. Sometimes it can significantly worsen the patient's quality of life. Acute, sudden, short time pain in the parotid gland region with irradiation to the ear during the first bite a meal is a characteristic for this syndrome. The correct diagnosis and individual approach in choosing a treatment method is the key to success in treating this complication. The purpose of our article is to supplement scanty data on this complication in Polish literature.
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