Tumores parafaríngeos y paragangliomas cervicales, revisión de 10 años.

Abstract

TITLE: Parapharyngeal tumors and cervical paragangliomas, revision of 10 years. Authors: CIFUENTES NAVAS- Viviana Andrea;TORRES MORIENTES-Luis Miguel; FERNÁNDEZ RODRÍGUEZ- Ana;SANTOS PÉREZ-Jaime;CARRANZA CALLEJA- María Antonía; MORAIS PÉREZ- Darío.  INTRODUCTIONTumors of the parapharyngeal space (PS) are infrequent, being diagnosed mainly in adults, and occasionally in children. The publications about treatment and diagnosis is really limited. For this reason, they represent a diagnostic and therapeutic challenge. Diagnosis includes clinical, physical examination and radiological studies, especially magnetic resonance imaging (MRI), although the definitive diagnosis is anatomopathological examination. The use of fine needle aspiration (FNA) is controversial and if it is always used, it should be done with imaging studies. A wide spectrum of malignant and benign tumors are found in this anatomically complex region, with 70-80% of benign nature. Parapharyngeal tumors represent of 0.5% of neoplasms of the head and neck; of them, the neoplasms of the salivary glands correspond in approximately 40-50%, followed by neurogenic tumors in 30% (neurinomas the most frequent and vagal, carotid and jugular paragangliomas), and a miscellaneous group in 20% (metastatic lymphadenopathies , lymphomas, lipomas and others). Cervical paragangliomas (PC) are neurogenic excision tumors derived from neural crest cells and the neuroendocrine system. They can be sporadic or familiar and exceptionally they are malignant. They are classified mainly in carotid paragangliomas (60-70%), yugulotimpánicos (30%) and vagal (2-3%). The vagal paragangliomas, some jugular and those carotids that surpass the posterior belly of the digastric muscle are considered part of the wide range of parapharyngeal tumors. MATERIALS AND METHODS:We present a retrospective study of 12 patients with parapharyngeal tumors and cervical paragangliomas treated surgically in our hospital between 2013 and 2018. The method used was the review of medical records, analyzing patient data; as tumor type, pathological anatomy, imaging tests, treatment, surgical approaches as well as functional sequels of the patients.   RESULTS: In our study predominated female patients 11 (69%) and 5 (31%) men. The age range of our study group was broad ranging from 17 years to 80 years. From the anatomopathological point of view, the most frequent tumors were the carotid paraganglioma with 38% (6), followed by pleomorphic adenomas with 25% (4), vagal paragangliomas 25% (4), cervical sympathetic chain schawanoma 6% (1) and parotid basal cell adenoma 6 % (1).  All patients were treated with surgery by cervicotomy + excision of the tumor ( there was a exception in one of the case), in the case of tumors of neurogenic or vascular origin, an angiographic study and previous embolization were performed. The resction of the tumours was complete in almost of the patients; there was a case because of the age and the pluripatology in wich we decided to have a expectant aptitude. CONCLUSIONSThe parapharyngeal space and cervicals paragangliomas tumors represent a group of infrequent and complex neoplasms due to their anatomical location and the possible complications derived from the treatment. They entail a challenge for the otolaryngologist, especially considering the broad histological range that may be present. Imaging (MRI) and angiographic studies will allow us to suspect the nature and origin of the tumor. In certain cases we will need angiograms and eventual embolizations. Biopsies are not indicated if it is not in the context of exeresis surgery. Surgical resection is the choice therapy, which can be done through a transcervical or transcervical-transparotid approach, without the necessity of major reconstructive procedures. For the few cases with extended commitment to the base of the skull, there are broader approaches that also allow resection. Associated comorbidities can be avoided with proper planning and surgical technique. Postoperative morbidity is mainly due to the neuropathies of the low cranial nerves that occur in the resection of neurogenic tumors or tumors of a malignant nature. The evolution and the eventual management with coadyuvance depend on the histology and the complete tumor resection.