Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2024, Vol. 38 ›› Issue (4): 28-35.doi: 10.6040/j.issn.1673-3770.0.2023.098

• Original Article • Previous Articles    

Surgical treatment of lesions of the upper parapharyngeal space by endoscopic prelacrimal recess-transpterygoid approach

HOU Jie, LIU Dingding, WANG Handong, QIAN Xiaoyun, GAO Xia, YU Chenjie   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu Provincial Key Medical Discipline (Laboratory), Research Institution of Otolaryngology, Nanjing 210008, Jiangsu, China
  • Published:2024-07-09

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Abstract: Objective In this study, we aimed to evaluate the feasibility of the operative method, indications, and clinical outcomes of the endoscopic prelacrimal recess-transpterygoid approach for treating lesions in the upper parapharyngeal space. Methods We retrospectively analyzed 10 cases of upper parapharyngeal space lesions between February 2016 and August 2021. Enhanced MRI and CT scans were performed before surgery. All the patients underwent endoscopic surgery, during which the pterygoid process was exposed by removing the anterior and medial walls and soft tissues in the pterygopalatine fossa through a prelacrimal-recess approach. Furthermore, using the eustachian tube, musculus palatosalpingeus, medial pterygoid muscle, and lateral pterygoid plate as reference marks, lesions in the upper parapharyngeal space were removed under image-navigation-assisted endoscopic surgery. A week after the surgery, enhanced MRI reinspection was performed to assess the characteristics, complications, and surgical outcomes. Results All patients' lesions were fully exposed by endoscopic prelacrimal-recess - transpterygoid approach. Among the ten cases, three cases of cavernous hemangioma, two cases of lymphoma, four cases of inflammation/inflammatory pseudotumor, and one case of nasopharyngeal carcinoma were confirmed through histopathological and immunohistochemical examination. Among these, all cavernous hemangiomas were totally removed, whereas lymphomas, and inflammation/inflammatory pseudotumors, nasopharyngeal carcinoma were subtotally removed after surgery. During the post-surgery follow-up period of 6-28 months, all the cases of hemangioma exhibited no recurrence, lymphoma cases exhibited complete remission after chemotherapy, inflammation/inflammatory pseudotumor cases exhibited no significant change compared with their post-surgery condition, and nasopharyngeal carcinoma case exhibited complete remission of nasopharyngeal disease after radiotherapy. Additionally, postoperative hard palate numbness on the affected side occurred in all 10 patients, four cases of hard palate numbness exhibited no remission. Conclusion The endoscopic prelacrimal-recess-transpterygoid approach effectively exposed the upper parapharyngeal space. The eustachian tube, musculus palatosalpingeus, medial pterygoid muscle, and medial pterygoid plate can be used as anatomical reference marks in this area to facilitate removal of lesions while protecting vital structures of the skull base. This approach is advantageous for the removal of lesions located in the upper parapharyngeal space.

Key words: Upper parapharyngeal space, Prelacrimal recess, Pterygoid process, Endoscopic, Hard palate numbness

CLC Number: 

  • R765.9
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