Parapharyngeal Space Neoplasms: A 50-Year Experience

Abstract

Objectives:

(1) Describe the presentation, histopathology, and workup for parapharyngeal space (PPS) neoplasms. (2) Analyze management and long-term oncologic outcomes.

Methods:

A chart review was performed from 1960-2010 on patients with primary PPS neoplasms treated at a tertiary center with intent-to-cure.

Results:

A total of 381 patients were included (160 males; mean, 50.9 years; range, 2 days-89 years). The most common symptom was a neck mass (182/381, 48%). Of the patients, 78.7% (300/381) had preoperative imaging: 44% (167/381) had computed tomography and 41% (156/381) had magnetic resonance imaging. Of the patients, 20.2% (77/381) underwent fine-needle aspiration biopsy. A total of 299 tumors were benign (78.5%), pleomorphic adenomas comprising the majority (151/299, 50.5%). Eighty-two were malignant (21.5%), adenocarcinomas (16/82, 19.5%) being the most common. All patients underwent primary surgical management ± adjuvant therapy. The cervical-parotid approach was the most common (253/381, 66.4%), with mandibulotomies required in 4.5% (17/381). Postoperative cranial neuropathies were identified in 18.7% (70/374); 48.5% (34/70) were related to neurogenic tumors. No perioperative mortalities were reported. Mean follow-up was 89.9 months (N = 345; range: 1 month-42 years). The 5-/10-/ 20-year recurrence-free survival was 93.2%/86.3%/77.9% for benign and 48.2%/38.3%/21.3% for malignant lesions (P < .0001). The 5-/10-/20-year cancer-specific survival was 98.7%/97.9%/96.2% for benign and 59.0%/52.3%/14.0% for malignant lesions (P < .0001). The 5-/10-/20-year overall survival was 96.4%/89.3% /70.0% for benign and 56.0%/46.0%/7.3% for malignant lesions (P < .0001).

Conclusions:

While the rate of recurrence for benign PPS lesions is low, these patients remain at risk for recurrence >20 years following surgery. Long-term surveillance should be considered. Patients with malignant lesions are at higher risk for recurrence and have a poor oncologic prognosis. The cervical-parotid approach remains safe and effective for most PPS neoplasms.