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Surgical approaches to the parapharyngeal space. A comparison of external and endoscopic approaches. Systematic review

https://doi.org/10.14201/orl.31852

Abstract

Introduction and objective: The parapharyngeal space is a deep craniocervical space where primary tumors are exceptional, constituting only 0.5% of all head and neck neoformations. Benign lesions represent 70-80%, with pleomorphic adenoma being the most frequent tumor in this location. The treatment of choice at present continues to be complete surgical resection of the lesion. Although classically the most commonly used surgical approach has been the external approach, nowadays, with the appearance of endoscopic techniques, new methods of approach useful for the resection of parapharyngeal tumors have been described. Methods: We present a systematic review of external, endonasal and transoral surgical approaches to the parapharyngeal space, with a total of 1725 patients and 92 (sides) of cadavers where the type of approach used/studied in each surgery was analyzed, comparing both the advantages and disadvantages offered by each of them. Results: The systematic review has a total of 40 articles, 1654 patients and 92 (sides) of cadavers where the type of approach used/studied in each surgery was analyzed. Discussion: External approaches have classically been the most used type of surgical approach. They present important advantages such as being the only type of approach with which the surgical field is completely exposed. The drawbacks include a great impact on the functionality of the tissues, a wide variety of postoperative complications and a longer surgical time and hospital admission time. Endoscopic approaches have had great development in recent years and present advantages such as being less damaging surgeries in terms of tissue functionality, avoiding facial scars or more comfortable and less painful post-operative treatments for the patient. But they also have drawbacks such as a lack of space or surgical scope of the technique and a limited application, which depends on both the size and type of tumor that the patient has. Conclusions: Although traditionally the most commonly used surgical approach has been the external approach, in recent decades and especially strikingly and relevantly in recent years, endoscopic surgery has been a revulsive when performing surgeries in this location. Both endonasal and transoral endoscopic approaches, with or without the use of robotic technology, have made it possible to operate on parapharyngeal lesions with less functional repercussions, a more comfortable and less painful postoperative period, and less prolonged hospitalization than with traditional techniques.
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Losada-Campa, J., Torres-Morientes, L. M., Pastor-Vázquez, J. F., Tamayo-Gómez, E., Martín-Fernández, M., & Santos-Pérez, J. (2024). Surgical approaches to the parapharyngeal space. A comparison of external and endoscopic approaches. Systematic review. Revista ORL, 15(2), e31852. https://doi.org/10.14201/orl.31852

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