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Surgical anatomy of the parapharyngeal space: Multiperspective, quantification‐based study
Author(s) -
Ferrari Marco,
Schreiber Alberto,
Mattavelli Davide,
Lombardi Davide,
Rampinelli Vittorio,
Doglietto Francesco,
Rodella Luigi Fabrizio,
Nicolai Piero
Publication year - 2019
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25378
Subject(s) - neurovascular bundle , parapharyngeal space , medicine , skull , cadaver , anatomy , infratemporal fossa , surgery
Background Several surgical approaches to the parapharyngeal space (PPS) have been proposed. An objective description of advantages and limitations of the surgical routes is lacking. Methods 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. Neurovascular and musculoskeletal structures encountered were analyzed. A navigation‐based quantification of working volume and exposure of PPS compartments was accomplished. Results Transnasal approaches exposed the upper PPS, though with limited working volume. Transoral approaches exposed the middle PPS, minimizing neurovascular structures crossed. Only transcervical and skull base approaches exposed the entire PPS, crossing several neurovascular structures. Conclusion 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.