Clinical Analysis And Treatment Options Of Parapharyngeal Space Tumors

Objective:To analyze the clinical characteristics of parapharyngeal space tumors,including clinical manifestations,imaging features,pathological types,postoperative complications,treatment methods and prognosis,and provide evidence for the diagnosis and treatment of parapharyngeal space tumors.Methods:A retrospective analysis of the clinical data of patients with parapharyngeal space tumors hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery,Jilin University First Hospital from January 2010 to October 2020,excluded patients with incomplete imaging data and a total of 56 cases were screened out among the cases,there are 22 males and 34 females,aged 4 to 80 years,with an average age of 47.29±16.84 years.56 patients underwent CT and/or MRI examinations,3 patients suspected of vascular origin or closely related to blood vessels underwent CTA examination,2 patients underwent PET-CT examination,and the remaining auxiliary examinations included 10 cases with electronic laryngoscopy.Seventeen patients underwent cervical color Doppler ultrasound examination,two underwent acoustic impedance and electrical audiometry examinations,and one underwent ultrasound-guided needle biopsy.Result:After evaluating the patient’s condition,the treatment plan was determined.Among the 56 patients,1 patient underwent ultrasound-guided puncture,and the pathologically lymphoma patient went to the department of hematology chemotherapy.5 patients selected follow-up observation,50 patients had surgery,and 3 patients had surgery for recurrence,two operations were performed respectively.The surgical approach of 53 cases included 44 cases using trans-cervical approach,7 cases using transoral approach,and 2 cases using trans-parotid approach,5 patients underwent tracheotomy during operation.A total of 54 cases of parapharyngeal space tumors had histopathological examination,47 cases of benign tumors(87.0%)were more common in women,including 13 pathological types,including schwannomas(19 cases,35.2%)and pleomorphic adenomas(17 Cases,31.5%),other pathological types include neurofibroma,myoepithelioma,epidermoid cyst,lipoma,teratoma,basal cell adenoma,bone tumor,granular cell tumor,ectopic meningioma,angiofibroma and angioma,1 case each;2 cases(3.7%)of borderline tumors,the pathological type was intermediate mesenchymal tumors,5 cases(9.3%)of malignant tumors,mostly male,the pathological types were respectively Lymphoma,rhabdomyosarcoma,aggressive fibromatosis,undifferentiated sarcoma,non-specific adenocarcinoma.In imaging,malignant tumors are more unclear than benign tumors.Compared with tumors from other sources in the parapharyngeal space,salivary gland-derived tumors are mostly located in the anterior styloid space,and the tumors are more likely to have unclear boundaries and no fat with the parotid gland.Most of the neurogenic tumors are located in the space behind the styloid process,and the borders of the tumors are smooth,and most of them can be seen in the fat layer between the parotid gland.The above differences are statistically significant.Complications are mainly various nerve injuries.The most common facial paralysis is 11 cases,hoarseness and drinking water coughing in 4 cases,Horner syndrome in 2 cases,oropharyngeal swelling in 3 cases,tongue extension in 1 case,and upper extremity in 1 case.There was 1 case of sexual extension weakness,1 case of ear numbness,and 2 cases of first chewing syndrome.One case of cerebrospinal fluid leakage after operation.There were 10 complications that did not recover more than half a year after the operation,and one patient died of hemorrhage on the 5th day after the operation.The follow-up time was 4-95 months,and the follow-up rate was 92.9%.Of the surgically treated patients,4 cases were lost to follow-up,41 cases had no recurrence during follow-up,and 1 out of 5 relapsed patients showed no recurrence after reoperation.Although the remaining 4 cases were actively treated with surgery or radiotherapy and chemotherapy,they still died of tumors.Of the 5 patients selected for follow-up,2 patients chose surgical resection due to tumor enlargement,and 3patients continued to follow-up.One patient with lymphoma was still undergoing regular chemotherapy in the department of hematology until follow-up.Conclusions:1.The incidence of parapharyngeal space tumors is most common in middle-aged people aged 40 to 60,most of which are benign,mostly women,and malignant are rare and more common in men.2.When there is an unclear boundary between the tumor and the surrounding tissues on imaging,the first consideration should be whether it is a malignant tumor.Benign salivary gland tumors can also have similar manifestations,but salivary gland tumors are mostly located in the prestyloid space,and tumors can be seen on the image.The boundary is fuzzy and there is often no fat boundary with the parotid gland.3.Neurogenic tumors of the parapharyngeal space are more common in the posterior styloid space.Fat pads are often seen between the parotid glands.Compared with tumors of other sources,it is more likely to have serious or permanent complications after surgery.The treatment plan should be formulated after comprehensively weighing the pros and cons of surgery.