PARAPHARYNGEAL SPACE NEOPLASMS

Background. Primary parapharyngeal space neoplasms are rare. Tumor dis tribution characteristics and long-term outcome have been quite variab le in the recent literature. We report the results of a retrospective review of 172 patients with primary parapharyngeal space neoplasms tre ated surgically from 1960 to 1990 at a large multispecialty clinic and teaching hospital. Methods. Initially, 195 patients seen at our insti tution were found to have parapharyngeal space neoplasms. Twenty-three patients previously treated elsewhere were excluded. The remaining 17 2 patients (96 female and 76 male) were from 11.7 months to 91.5 years of age. All patients were treated surgically; the transparotid-cervic al approach was most widely used. Results. One hundred thirty-seven tu mors (80%) were benign and 35 (20%) were malignant. High-resolution co mputed tomography or magnetic resonance imaging was essential in the d iagnosis and presurgical planning. Fine-needle aspiration specimens we re accurate in the diagnosis of 8 of 9 cases. Pleomorphic adenoma was the most common neoplasm (40%), followed by paraganglioma (20%), neuro genic tumor (14%), malignant salivary gland tumor (13%), miscellaneous malignant tumors (7%), and miscellaneous benign tumors (6%). Mandibul otomy was required for only 6% of all tumors; its use was reserved for malignant lesions and large skull base tumors when risk of tumor rupt ure was high. Recurrent or persistent disease was recorded in 27 patie nts with malignant tumors; of these, 24 (89%) are likely to die of dis ease. Conclusions. The transparotid-cervical approach is the preferred procedure for most parapharyngeal tumors and can be combined with mid line mandibulotomy for large vascular or selected malignant tumors. Re currence after removal of pleomorphic adenomas is only 4%. Recurrent o r persistent malignant disease is nearly always fatal. Perioperative m ortality is zero, and morbidity is most often associated with cranial nerve neuropathy. (C) 1995 John Wiley and Sons, Inc.