Oral and maxillofacial surgery
A comparative study of the endoscopy-assisted transoral approach versus external approaches for the resection of large benign parapharyngeal space tumors

https://doi.org/10.1016/j.oooo.2016.09.010Get rights and content

Objective

The advantages and limitations of the endoscopy-assisted transoral approach (EATA) and external approaches (EAs) in resection of parapharyngeal space tumors (PSTs) remain unclear. In our study, we compared the use of the EATA and the EAs for the resection of large, benign PSTs.

Study Design

Forty-four patients with PSTs were divided into the EATA and EA groups. The perioperative and postoperative outcomes of the patients were evaluated.

Results

All of the tumors were completely removed. However, the procedure was converted to an open procedure for four patients in the EATA group and for six patients in the EA group who required endoscopic assistance. The intraoperative blood loss, amount and duration of drainage, postoperative pain, total hospital stay, and cosmetic outcomes were superior in the EATA group (P < .05).

Conclusions

Use of the EATA for resection of large, benign PSTs decreased the surgical invasiveness of the procedure and resulted in better aesthetic outcomes. However, use of the combined surgical approach allowed for improved access for the resection of PSTs.

Section snippets

Patients

Forty-four patients with PST treated between January 2010 and February 2015 at the Department of Oral and Maxillofacial Surgery at Sun Yat-Sen Memorial Hospital were selected for participation in this retrospective study. All patients consented to the procedures after they were fully informed about the advantages and disadvantages of the different procedures, including the EATA and the transcervical, transparotid, transmandibular, and combination approaches. After the patients provided informed

Results

Patient age and gender, tumor size, and pathologic diagnoses of the two groups did not differ significantly (Table I).

All of the tumors in both the EATA and EA groups were completely resected. The mean operation time for the EATA (88.6 ± 15.9 minutes; range 63.2-148.5 minutes) and EA (91.4 ± 12.4 minutes; range 53.4-139.7 minutes) groups were comparable. The mean blood loss during the operation for the EATA group (93.7 ± 10.6 mL; range 23.5-180.5 mL) was significantly less than that for the EA

Discussion

Patients with PSTs often exhibit no significant symptoms during the early phase, and PSTs are typically detected via imaging or physical examination as a result of their unique positions and the anatomic structures in the parapharyngeal space. However, these tumors can cause some symptoms, such as foreign body sensations; obstructive symptoms; dysphagia; snoring; and cerebral or sympathetic nerve dysfunction, including pain, hearing loss, or even expiratory dyspnea, as the tumor size increases

Conclusions

Both the EATA and the EAs enabled effective excision of the PSTs. The EATA resulted in decreased blood loss, fewer complications, decreased postoperative pain, a shorter hospitalization time, and a superior cosmetic appearance. However, both approaches have limitations with regard to the establishment of safe operative boundaries and surgical invasiveness. With continued efforts toward improving minimally invasive approaches and patient surgical outcomes, we believe that combined surgical

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These authors contributed equally to this work.

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