Outcome of treatment in locally advanced parapharyngeal tumors.

Abstract

Parapharyngeal tumors are uncommon and a challenge to the surgeon as they are large and intimately related to carotids and lower cranial nerves at the time of presentation. This was a retrospective study of 36 large parapharyngeal tumors operated at a tertiary care rural hospital. Seventy eight percentage of tumors were benign, most common being schwannoma followed by pleomorphic adenoma. Most common malignant tumor was mucoepidermoid carcinoma (19%). Pre operative imaging and fine needle aspiration biopsy helped in diagnosis and planning of surgical approach. Tumors of neural origin were post-styloid and salivary origin tumors were pre-styloid. Majority of patients presented with large neck swelling and 28% had medial displacement of tonsil compromising the oropharyngeal space. 11% presented with stridor requiring emergency tracheostomy. Cervical with transparotid approach was most common surgical approach followed by only cervical approach. FNAB correlated with histopathology report in 94% patients. Transient paralysis of lower division of facial nerve was the most common complication. Only 2 patients required sacrifice of facial nerve and in one of them nerve was grafted. Only 1 patient in this series had permanent paralysis of vagus and hypoglossal nerve. A 22% of them were malignant salivary tumors and one of them recurred leading to death. Benign tumors did not recur. In our experience these challenging tumors have a good outcome but require meticulous planning and surgery.