Parapharyngeal Space and Upper Lateral Neck Tumor Surgery

The tumors of the parapharyngeal space can be salivary and neurogenic (paraganglioma). It can also be benign and malignant. The neurogenic tumors or their removal may cause preoperative or postoperative functional problems, namely, swallowing, speech, and airway. The small- or medium-sized tumors of the parapharyngeal space are removed by transcervical with or without transparotid approach. The tumor is removed with a combination of sharp and blunt dissection through the looser areolar tissues surrounding the tumor. Blunt finger dissection is used to mobilize the medial and superior portions of the tumor. During this process, the mandibular branch of the facial nerve, spinal accessory nerve, carotid sheath, and hypoglossal nerve have to be protected. Larger tumors or those tumors encircling the neurovascular bundle of the carotid sheath or malignant ones require transmandibular approach. Malignant tumors may require removal of additional structures, namely, facial nerve, masseter muscle, mandibular ramus, and pterygoid plates.