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Most Parapharyngeal Space Masses Benign, Removed Through Surgery

by Amy Hamaker •

Clinical Question

What are the clinical parameters of parapharyngeal space masses, and do they have an effect on surgical approach?

Background: Lesions of the parapharyngeal space account for 0.5% to 1% of all head and neck masses. They are normally confined to treatment within a tertiary referral center due to their histological diversity and complex surrounding anatomy. So far, cumulative literature on this topic is limited to single-center case reports or case series.

Study design: Systematic review of literature on 1,252 lesions, published over the past 25 years (1988–2014); authors include their own experience of 41 cases.

Setting: Department of Otolaryngology–Head and Neck Surgery, Addenbrooke’s Hospital, United Kingdom; MEDLINE and Embase databases.

Synopsis: In the cumulative series, excluding metastatic lesions, there were 1,221 primary cases, of which 1,001 (82%) were benign and 220 (18%) malignant. The most common lesions were pleomorphic adenomas (29%). Of the malignant lesions, the most common pathology was adenoid cystic carcinoma (3%). The most frequent symptom was a cervical mass or an intraoral swelling, which was present in about half of the cases (49%). The most common sign was an intraoral swelling reported in 52% of the cases and a cervical mass reported in 48%. In the 17 series that described the surgical approach (797 patients), the most common approach was cervical (46%). Overall, the most common complications were cranial nerve injuries, with the vagus nerve most commonly affected. The most common sign of metastatic lesions was a cervical mass affecting 71% of patients, followed by an intraoral mass distorting either the soft palate or tonsils, affecting 37% of patients. The cervical-parotid surgical approach was most common (54%). There were no peri-operative mortalities. Cranial nerve palsies were demonstrated to be a frequent occurrence. Limitations include the omission of the exact histological diagnosis for some studies.

Bottom line: Review of the cumulative data reveals that 82% of parapharyngeal space lesions are benign; the most common lesions were pleomorphic adenomas, and the vast majority of patients undergo surgery to remove the lesion.

Citation: Kuet ML, Kasbekar AV, Masterson L, Jani P. Management of tumors arising from the parapharyngeal space: a systematic review of 1,293 cases reported over 25 years. Laryngoscope. 2015;125:1372-1381.