Surgical anatomy of the parapharyngeal space: a multiperspective, quantification-based study

Abstract

Several surgical approaches to the parapharyngeal space (PPS) have been proposed. An objective description of advantages and limitations of the surgical routes is lacking [1, 2]. Ten cadaver heads were dissected using the transnasal (medial, lateral), sublabial, transoral (transpharyngeal, transvestibular, transmandibular), transcervical (transcervical, transparotid, transmandibular, transmastoid), and type C and D infratemporal approaches. Neurovascu- lar and musculoskeletal structures encountered were analyzed. A navigation-based quantifi- cation of working volume and exposure of PPS compartments was accomplished. Transnasal approaches exposed the upper PPS, though with limited working volume. Transoral approach- es exposed the middle PPS, minimizing neurovascular structures crossed. Only transcervical and skull base approaches exposed the entire PPS exposing several neurovascular structures. A tentative systematization of the surgical approach(es) to PPS in relation to different targets is provided: unicompartmental resection can be performed with a single, conservative access, whereas multicompartmental dissections frequently require a wider or multiportal approach.