A study of tumors of the parapharyngeal space

A retrospective study of patients with parapharyngeal tumors has been completed, and this report concerns 40 patients cared for during the years 1962–1973. The parapharyngeal space is a potential anatomical space with three rigid walls so that growth of a tumor proceeds either medially or inferiorly or both. This pattern of growth accounts for the distinct clinical appearance of a displaced palate and pharynx. As noted in this series of cases, Table I depicts the types of tumors which involved the parapharyngeal space. Eighty‐two percent of the cases presented with benign tumors. On the other hand, 18 percent of the patients had malignant tumors. Benign mixed cell tumors and schwannomas are the most commonly noted benign tumors. Several cases presented with unusual tumors. In most patients the tumor was discovered on routine physical examination. Arteriography has become a valuable and safe diagnostic study. These procedures often help the surgeon to determine the extent of tumor, vessel displacement and the possibility of chemodectoma and even malignancy in some patients. An external surgical approach is recommended for surgical excision of the benign parapharyngeal tumor in most patients. Intraoral incisional biopsy in patients with benign tumors is to be avoided because of dangers of vessel and nerve injury as well as “seeding” of the biopsy site. On the other hand, malignancy may be diagnosed with incisional biopsy either performed externally or intraorally, depending on the judgment of the surgeon as to the anatomical location and site of the neoplasm. In final analysis the external surgical approach allows the surgeon systematically to identify tumor, important cranial nerves including the facial nerve and the great vessels. Every effort should be made by the surgeon not to violate the capsule of a benign mixed tumor during its removal. Removal of tumor is enhanced frequently by preliminary excision of the submandibular gland, vessel ligation and mandibulotomy. In the latter instance the patient must undergo tracheostomy. Postoperative cranial nerve palsies occurred for the most part in those patients who underwent surgical excision of schwannomas. These tumors originated from the vagus nerve or cervical sympathetic chain. Sacrifice of these nerves during removal caused little morbidity. Follow‐up examinations in this series of patients revealed that if benign tumors are removed from the parapharyngeal space in a deliberately planned manner, recurren