Management of Parapharyngeal Benign Tumors via Combined Transcervical–Submandibular and Transoral Endoscopic Approach

ABSTRACT Background To compare outcomes of the combined transcervical–submandibular and transoral endoscopic approach versus the open transcervical parotid approach and transoral endoscopic surgery alone, and to clarify the indications and advantages of the combined technique. Methods This retrospective observational study was conducted at a tertiary academic hospital in China between January 2013 and December 2024. A total of 114 consecutive patients with histologically confirmed benign parapharyngeal space tumors underwent the open transcervical parotid approach ( n = 48), transoral endoscopic surgery alone ( n = 42), or the combined transcervical‐submandibular and transoral endoscopic approach ( n = 24). Tumor size, intraoperative blood loss, hospitalization duration, tracheotomy rates, en‐bloc resection rates, and surgery‐related complications were compared among the three groups. Results The combined surgery group had significantly larger tumors and a lower incidence of surgery‐related complications. No statistically significant differences were observed among the three approaches in tracheostomy rates, intraoperative blood loss, operative duration, or hospitalization duration. Conclusions The combined approach appears effective in reducing complications associated with resection of large, anatomically complex benign parapharyngeal tumors, particularly those involving critical neurovascular structures. This technique shows clinical value and warrants broader application.