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The parapharyngeal space is a complex anatomical space bounded medially by the oropharynx and laterally by the mandible. It is conceptualised as an inverted pyramid extending from base of skull above to the hyoid bone below. The space is divided by the stylohyoid ligament into prestyloid and poststyloid compartments. Common tumours in this space include deep lobe parotid tumour, lipoma, schwannoma, lymphoepithelial cysts and malignant salivary neoplasms. Traditionally a transcervical approach is used for excising these tumours. With the expansion of intraoperative technology, including rigid endoscopy and transoral robotic surgery (TORS), transoral approaches to PPS masses are gaining more popularity, mainly due to improved visualisation and enhanced tissue manipulation that these techniques offer. The senior author in this article highlights clear indications, limitations, benefits and disadvantages of different transoral approaches, including transoral approach, endoscope-assisted approach and TORS. He further expands on their operative setup, surgical technique and management of complications. It recommends that in certain situations, such as for large tumours - especially those that extend beyond the stylomandibular tunnel - a transcervical assist approach may be required. We found this article very useful and practical, and feel that the endoscope-assisted or TORS approach has a significant potential to reduce patient’s morbidity, reduce in-hospital stay, and could offer better outcome to our patients. The senior author does acknowledge that long-term outcome data is still required to assess the QOL and also to compare tumour recurrence rates between the traditional transcervial approaches to transoral approaches.

Transoral Excision of Parapharyngeal Space tumors
Larson AR, Ryan WR.
OTOLARYNGOL CLIN N AM
2021;54(3):531-41.
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CONTRIBUTOR
Sangeeta Maini

FRCS ORL-HNS, Aberdeen Royal Infirmary, Forresterhill, Aberdeen, AB25 2ZN.

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CONTRIBUTOR
Bhaskar Ram

FRCS (EDIN) , FRCS ORL-HNS, Department of Otolaryngology Head & Neck Surgery, Aberdeen Royal Infirmary, Forresterhill, Aberdeen AB25 2ZN, UK.

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