Cirugía robótica transoral en un tumor parafaríngeo de gran tamaño, a propósito de un caso

Abstract

Introduction: The parapharyngeal space is a complex anatomic space. The tumours that surge in this region are rare and surgery is considered the first option of treatment in most of the cases(1). Although traditionally large tumours in this space are approached through the neck, transoral robotic surgery (TORS) brings great benefits, being even more safe, less morbid and potentially more effective, clearly improving postoperative outcomes in the patient, with less pain, less risk of damaging nerves and vessels and a faster recovery. TORS allows the exéresis of masses up to 8cm, as it has been published in some case reports(2). We present the case of a patient with a large cervical mass in the parapharyngeal and retropharyngeal right space that was resected with TORS.   Method: We present a 21 years old patient with medical history of neurofibrotosis type 1 that presents with a large cervical mass located in the parapharyngeal and retropharyngeal right space of 71 x 32 x 45 mm of diameter in craniocaudal, anteroposterior and transverse projections, apparently dependent of the sympathetic cervical chain. At the time of the diagnosis the patient reports no symptoms but during the follow up with magnetic resonance it is observed that the mass has grown and the patient tells swallowing disturbances accompanied by voice changes produced by the occlusion of the oropharynx. It is then decided to have surgery to remove the mass through transoral robotic surgery (TORS). During the postoperatory time, the patient presented with a transitory Horner’s syndrome due to sympathetic cervical chain involvement. He also presented trismus and paresis of the XII cranial nerve due to the compression made during surgery, which improved thanks to logotherapy treatment. Histopathologically the tumour was diagnosed as “intraneural neurofibroma grade I (WHO)”. Discussion:  TORS is an emerging solution for the resection of tumours in the paraphyngeal space (1,2,3,4). With the technological advances its indication has been wide spreaded in tumours with bigger size in which the professional must take into account   multiple factor regarding the type of patient in which it is essential a good mouth opening, and specific characteristics of the tumours, like de histopathology of the lesion, its extension laterally and craniocaudal and the relationship with the carotid artery, among other aspects(2). Conclusions: TORS shows a decrease in morbility when an addecuate selection of the patiente is made(1,2). In the case we present the whole mass was resected although its large size. It is necessary to keep record of the long term results of this type of surgical approach in order to determine its advantages over open approach.