G. Madhusudhan Reddy1, D. Satyanarayana2, S. Muneeruddin Ahmed3
INTRODUCTION: Parapharyngeal space tumors are rare, but are reported all over the world with an incidence of 0.5% of Head and Neck tumors. Parapharyngeal space is a potential space lateral to the upper part of pharynx extending from base of the skull to the Hyoid bone. It contains important and vital structures connecting the Head and thorax. The importance of the tumors of this space lies in the fact that its approach from outside (Trans cervical) is a surgical challenge and from within (Transoral) does not give a good vascular control. Improved visibility and monitored dissection is reported with the use of endoscopes to assist Transoral approach to parapharyngeal tumors excision is reported from all over the world. A retrospective study of sinus endoscopes assisted excision of parapharyngeal tumors was conducted at the Government Hospital attached to Kakatiya Medical College, Thiruvananthapuram, Telangana between August 2012 and July 2013.
MATERIALS AND METHODS: 19 patients were operated for Para-pharyngeal tumors. All the tumors were benign in nature. They included 9 tumors of mixed salivary gland type, 6 were neurogenic, 2 were Schwanomas and 2 were lipomas. Operative notes and video films of the surgical procedure undertaken by different surgeons are the source of the present study.
OBSERVATIONS: The diagnosis of all the tumors was based on HRCT of the neck. Pre-operative arteriogram was not undertaken in any of the patients. HRCT helped to determine the size and extent of the tumor and to differentiate tumors of parotid and extra-parotid origin and to demonstrate degree of tumor vascularity. Sensitivity to differentiate between benign and malignant tumors with HRCT was found to be 97%. The tumor resectability was judged by the presence of fat at the periphery of the tumor which gives low density marking. Sinus endoscope (Zero degree and thirty degree) was found to be useful to magnify, observe the cleavage of dissection behind the tumor mass intra-operatively.
CONCLUSIONS: Sinus endoscope assisted dissection of parapharyngeal tumors of parapharyngeal tumors is superior to naked eye dissection, as it guides the surgeon to visualize the cleavage between the tumor and the normal tissue. It gives a haemostatic control over minor bleeding vessels. It gives a magnified recording facility.