Surgical approaches for removal of parapharyngeal space tumors. (A literature review)

Background. Parapharyngeal space tumors represent 0.5% of all head and neck tumors. Various surgical approaches have been proposed for the removal of tumors of this location. The choice of the approach depends on many factors, but this decision is often subjective and depends on the surgeon’s preferences and experience. Objective. To summarize current literature data on the criteria for selecting the optimal surgical approach for the removal of parapharyngeal space tumors. Material and methods. A review of over 70 literature sources dedicated to the anatomy and surgical approaches used for removal of the parapharyngeal space tumors was done. Publications were searched for keywords in PubMed, ScienceDirect, Google Scholar, Web of Science, and eLibrary databases covering the past 10 years. Results. The article presents the indications and contraindications, advantages and disadvantages, as well as techniques of surgical approaches for the removal of tumors of the parapharyngeal space — submandibular, parotid-submandibular, and intraoral — including the use of endoscopic and robotic surgery, and combined techniques. Conclusion. The choice of surgical approach for the removal of tumors of the parapharyngeal space depends on the tumor’s volume, histological structure, and location. Most tumors can be removed using the submandibular approach, with the exception of tumors originating from the pharyngeal lobe of the parotid gland, for which the parotid-submandibular approach is recommended. The use of the intraoral approach, despite the introduction of endoscopic and robotic surgery, requires adherence to limited indications and strict patient selection.