1. Management of Parapharyngeal Space Tumor Using Transoral Robotic Surgery: The Tonsillar Fossa Battlefield
- Author
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Angelo Pio Moffa, Vittorio Rinaldi, Michele Cassano, Luciano Enrico Magaldi, Valeria Fiore, Manuele Casale, and Antonio Moffa
- Subjects
medicine.medical_specialty ,Biopsy, Fine-Needle ,Oral Surgical Procedures ,Adenoma, Pleomorphic ,Skull Base Neoplasms ,Pleomorphic adenoma ,Young Adult ,03 medical and health sciences ,Parapharyngeal Space ,0302 clinical medicine ,Vascularity ,Robotic Surgical Procedures ,Transoral robotic surgery ,medicine ,Parapharyngeal space ,Humans ,Parotid Gland ,030223 otorhinolaryngology ,medicine.diagnostic_test ,business.industry ,Cranial nerves ,Magnetic resonance imaging ,030206 dentistry ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Parotid gland ,medicine.anatomical_structure ,Otorhinolaryngology ,Tonsillar fossa ,Female ,Surgery ,Radiology ,medicine.symptom ,business - Abstract
Introduction The management of parapharyngeal space (PPS) tumors is surgical, but the approach remains a challenge. Attention should be paid to avoid intra-operative bleeding, cranial nerves damage, and external scars. Presentation of case The authors report a case of a 23-year-old female, with complaint of progressive, painless swelling just below the right angle of the mandible of 6-month's duration. Magnetic resonance imaging images reported the presence of an oval-shaped expansive lesion (maximum diameter 3 cm), from the lower polar region of the parotid gland while fine needle aspiration cytology (FNAC) was not diagnostic. We performed a Trans Oral Robotic surgical excision of the tumors with Da Vinci Robot. Discussion Thanks to a detailed magnification, the authors were able to reach the PPS region through the tonsillar fossa saving the palatine tonsil without any significant bleeding or nerve lesions. The histological examination confirmed the diagnosis of pleomorphic adenoma of parotid gland. The decision on which surgical approach to be used is determined by site, size vascularity, histology of the tumor, and knowledge of radiological images. Conclusion There is not only 1 surgical approach for PPS tumors but the surgeon must know all the different options and possible outcomes. Transoral Robotic Surgery approach with Da Vinci could represent a valid option with a good knowledge of Robot surgical instruments and a detailed preoperative plan.
- Published
- 2020