INTRODUCTION
The parapharyngeal space (PPS) is located lateral to the upper pharynx and medial to the mandible, from the hyoid bone caudally to the skull base. It is an inverted pyramid-shaped space divided into the prestyloid and poststyloid components by the tensorvascular-styloid fascia, running posteriorly from the styloid process to the tensor veli palatini muscle.1 PPS tumors account for only 0.5-1% of head and neck cancers, are generally located in the prestyloid, and are mostly benign.2,3 Surgery, the mainstay of treatment, can be challenging due to the PPS anatomical complexity and dense neurovascular network.2-4 It is essential to select the surgical approach with the least risk of postsurgical complications and the greatest possibility of complete resection, especially in malignant tumors.
Surgical approaches for prestyloid tumors can be classified as lateral or transoral/medial. Multiple lateral approaches have been used alone or in combination,2,3 including transcervical, transcervical-parotid, and transcervical-mandibular approaches. In contrast, until relatively recently, the medial approach was limited to small tumors near the constrictor muscle due to the limited visualization of the PPS with this approach.5 Over the last few years, however, the medial approach known as transoral robotic surgery (TORS) has become more prevalent.6 TORS provides a high-definition visualization of the PPS and allows access to narrow areas, enabling resection to be performed without haptic feedback. Although TORS cannot usually benefit from navigational systems due to soft tissue modification in surgical positioning, it is now recognized as an important surgical option – either alone or combined with a transcervical approach.7
Here we report our retrospective analysis of two surgical approaches used in our center for the resection of prestyloid tumors. We compare results using TORS assisted by navigational systems with those using lateral approaches in a series of 28 patients.