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.