Transoral endoscopic approach versus transcervical with or without mandibular swing approach to parapharyngeal space- a retrospective cohort study in a tertiary care center in Tamil Nadu


  • Sheetal Krishnappa Department of ENT, Karpaga Vinayaga Institute of medical Sciences and research center, Madurantakam, Tamil Nadu, India
  • Nikisha G. N. Department of ENT, Karpaga Vinayaga Institute of medical Sciences and research center, Madurantakam, Tamil Nadu, India



Head and neck neoplasms, Parapharyngeal space, Skull base


Background: The objective of this study was to evaluate and compare patient outcomes and advantages of endoscopic transoral approach to parapharyngeal space with other approaches like transcervical with or without mandibular swing approach.

Methods: In this retrospective cohort study, we have reviewed 13 cases of parapharyngeal space tumors resected with either trans oral endoscopic assisted approach or external approaches such as trans cervical and mandibular swing approach during the period of June 1, 2015 to May 31, 2020.  

Results: A total of 13 cases were included in the study. Among 13 cases, 9 were operated by transoral endoscopic approach, 2 by transcervical approach and 2 by transcervical with mandibular swing approach. Operative time (p=0.048), blood loss (p=0.028), hospital days (p=0.02) and postoperative patient satisfaction (p=0.008) were more in transoral route compared to transcervical route.

Conclusions: Transoral endoscopic route is a safe route of surgery with less morbidity, less complications, less chance of neurovascular injury and cosmetically more acceptable for the patient when compared to open procedures for smaller size tumors without vascularization, present in the upper part of the parapharyngeal space and without attachment to any neurovascular structures.


Dallan I, Seccia V, Muscatello L, Lenzi R, Castelnuovo P, Bignami M, et al. Transoral endoscopic anatomy of the parapharyngeal space: a step‐by‐step logical approach with surgical considerations. Head Neck. 2011;33(4):557-61.

Sataloff RT. Sataloff's Comprehensive Textbook of Otolaryngology: Head & Neck Surgery: Otology/Neurotology/Skull Base Surgery. Jaypee Medical Ltd; 2015:471-479.

Carrau RL, Myers EN, Johnson JT. Management of tumors arising in the parapharyngeal space. Laryngoscope. 1990;100(6):583-9.

van Hees T, van Weert S, Witte B, Leemans CR. Tumors of the parapharyngeal space: the VU University Medical Center experience over a 20-year period. Eur Arch Otorhinolaryngol. 2018;275(4):967-72.

Rodríguez-Ciurana J, Rodado C, Sáez M, Bassas C. Giant parotid pleomorphic adenoma involving the parapharyngeal space: report of a case. J Oral Maxillofac Surg. 2000;58(10):1184-7.

Duek I, Amit M, Sviri GE, Gil Z. Combined endoscopic transcervical‐transoral robotic approach for resection of parapharyngeal space tumors. Head Neck. 2017;39(4):786-90.

Goodwin Jr WJ, Chandler JR. Transoral excision of lateral parapharyngeal space tumors presenting intraorally. Laryngoscope. 1988;98(3):266-9.

Tateya I, Shiotani A, Satou Y, Tomifuji M, Morita S, Muto M, et al. Transoral surgery for laryngo-pharyngeal cancer–the paradigm shift of the head and cancer treatment. Auris Nasus Larynx. 2016;43(1):21-32.

Olsen KD. Tumors and surgery of the parapharyngeal space. Laryngoscope. 1994;104:1-28.

Locketz GD, Horowitz G, Abu-Ghanem S, Wasserzug O, Abergel A, Yehuda M, et al. Histopathologic classification of parapharyngeal space tumors: a case series and review of the literature. Eur Arch Otorhinolaryngol. 2016;273(3):727-34.

Eneroth CM. Salivary gland tumors in the parotid gland, submandibular gland, and the palate region. Cancer. 197;27(6):1415-8.

Patadia S, Keshri A, Shah S, Shrivastava A. Benign parapharyngeal tumours: surgical intricacies by transcervical approach. Otolaryngology. 2016;6(219):2.

Hughes III KV, Olsen KD, McCaffrey TV. Parapharyngeal space neoplasms. Head Neck. 1995;17(2):124-30.

Okamoto I, Tsukahara K, Sato H. Parapharyngeal space tumor surgery using a modified cervical-parotid approach. Acta Otolaryngol. 2018;138(2):165-9.

Elaprolu S, Ramasamy K, Karunakaran V, Alexander A, Ravichandiran SP. Mandibular swing approach for parapharyngeal tumor revisited-a rare case series. Dysphagia. 2018;2:20.

Pilolli F, Giordano L, Galli A, Bussi M. Parapharyngeal space tumours: video-assisted minimally invasive transcervical approach. Acta Otorhinolaryngol Ital. 2016;36(4):259.

Prasad SC, Piccirillo E, Chovanec M, La Melia C, De Donato G, Sanna M. Lateral skull base approaches in the management of benign parapharyngeal space tumors. Auris Nasus Larynx. 2015;42(3):189-98.

Paderno A, Piazza C, Nicolai P. Recent advances in surgical management of parapharyngeal space tumors. Curr Opin Otolaryngol Head Neck Surg. 2015;23(2):83-90.

Casale M, Capuano F, Sabatino L, Pace A, Oliveto G, Vella P, Moffa A, et al. A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland. SAGE open med case rep. 2016;4:2050313X16682131.

Casani AP, Cerchiai N, Dallan I, Seccia V, Franceschini SS. Benign tumours affecting the deep lobe of the parotid gland: how to select the optimal surgical approach. Acta Otorhinolaryngol Ital. 2015;35(2):80.

Meng LZ, Zhong Q, Fang JG, Ma HZ, Wang JH, Wei YX. Early experience in endoscopic transoral resection for parapharyngeal space tumors. Ear Nose Throat J. 2018;97(4-5):E5-9.






Original Research Articles