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This is a case of a 20 years young boy with a large parapharyngeal pleomorphic adenoma excised via transpalatal approach. The incision was taken about 0.5cm away from the edges of the tumor it provided good, surgical access to the whole length of upper parapharyngeal space and allowed complete tumor excision.
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The occurrence of multiple distinct tumors in major salivary glands is quite rare. Although the most common tumor with bilateral synchronous or metachronous development is Warthin's tumor, on rare occasions, pleomorphic adenomas have been diagnosed simultaneously as well. In this paper, we present the case of a 46-year-old man with bilateral metach...
Citations
... We used the oral approach for the removal of the lateral pharyngeal wall tumour because there was no swelling seen from outside, but generally the trans-cervical approach is recommended for the parapharyngeal tumours. Vaid et al. [20] said that a transoral approach offers direct route to tumours presenting in the oropharynx but provides no control of the great vessels. This approach is only for small lesions not extending to the styloid process. ...
Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.
... The vertical palatal split incision healed quickly and created none of the recognised complications commonly associated with palatal surgeries. This transpalatal approach has been successfully used by Myatt and Remedios (1997) [7] and N Vaid et al (2001) [8] to remove similar tumours. This approach has many advantages viz-short operative time, minimal bleeding, fast post-operative recovery and hardly any morbidity. ...
... The vertical palatal split incision healed quickly and created none of the recognised complications commonly associated with palatal surgeries. This transpalatal approach has been successfully used by Myatt and Remedios (1997) [7] and N Vaid et al (2001) [8] to remove similar tumours. This approach has many advantages viz-short operative time, minimal bleeding, fast post-operative recovery and hardly any morbidity. ...
... Many approaches have been described including transcervical (TC) approach, (11,12) transcervicaltransparotid (TC-TP) approach, (13) transpalatal or transoral one. (14) Access mandibulotomy (15) have been described as a complement to these approaches for very large and vascular tumours for which maximal exposure at the skull base is required for control of bleeding and for tumour removal. Transoral approach (11,12) offers a direct route to tumors present in the oropharynx; however this is rarely used nowadays, due to its risk of hemorrhage, infection, facial nerve injury and tumor implantation. ...
... The majority of these tumours are benign, so the aim of surgery is to totally excise the tumour with least morbidity. There are various approaches been described which are transcervical, (11,12) transparotid, (19) transcervicaltransparotid, (13) different transoral approaches (14) , and skull base approaches. (17) Access mandibulotomy may be associated with any of these. ...
Aim: The aim of this work was to assess the accessibility of the transcervical and the transcervical-transparotid approaches per se without access mandibulotomy for removal of benign parapharyngeal space (PPS) tumours and checking the probability of occurrence of any possible postoperative ENT morbidity. Methods: 16 patients had benign parapharyngeal tumours were subjected to surgical removal of these tumours. 13 of them were females and 3 were males. Their age ranged between 35 and 65 years old. The main diagnostic tool was CT scan. 12 (75%) of them had extraparotid origin (poststyloid) and were accessed transcervically and 4 (25%) originated from the deep parotid lobe (Prestyloid) and were accessed transcervically -transparotid. Results: All the tumours have been successfully removed without major reported complications and without a need to do access mandibulotomy, even for large sized tumours. All the symptoms improved without ENT morbidity. No tumour recurrence observed in the follow up period that extended for a mean of one year. Conclusion: Transcervical and transcervical -transparotid approaches were found to have a very good accessibility for removal of benign PPS tumours without the need for access mandibulotomy. .It has also a very good patient outcome regarding the occurrence of any ENT complications.
Objective:
Anterior craniovertebral junction (CVJ) surgery has continued to be one of the most debated neurosurgical topics. The transoral approach (TOA) has been considered the choice for this region. However, it has some limitations and a not negligible degree of surgery-related morbidity. With the advent of endoscopy, the endoscopic endonasal approach (EEA) was developed, which minimized morbidity and improved exposure. To the best of our knowledge, despite the extensive reported data, a comparative anatomical study has not been performed and no definitive consensus has been reached on the indications for both approaches.
Methods:
We compared the TOA and EEA to the CVJ using the previously described operability score (OS), calculated at 4 different targets: the C1 tubercle (C1), the lowest exposed point of the odontoid process (C2), the basion (BS) and the middle clivus (MC). The higher the OS for the selected targets, the more favorable the approach.
Results:
The TOA had higher OSs at the MC, C1, and C2 targets, and the EEA showed greater OSs at MC and C1. The TOA and EEA had similar OSs at the BS. These results have shown that the OS is more favorable at C1-C2 using the TOA and the OSs at the MC and BS were similar.
Conclusions:
The OS is an effective method to compare surgical approaches. The present study demonstrated the maximal exposure capability of the 2 approaches. The TOA seemed to be superior for lower targets and the EEA for upper targets. Because of the strong variability in the CVJ anatomy and pathological features, we suggest considering the OS as a further tool to better define the best surgical approach.
