What are they?
The parapharyngeal space is the anatomic region that stretches from the base of the skull to the hyoid bone in the neck. Its posterior wall is the cervical spine, its exterior wall is the jaw and the inner wall is the pharynx. It contains important vascular (inner carotid, inner jugular) and nervous (sympathetic cervical nerve and cranial nerves IX, X, XI, XII) structures.
Tumours that grow in this space are rare (0.5-1% of all the head and neck tumours).
These tumours do not present symptoms until they grow to 2-3 cm.
Which are their symptoms?
The main symptoms are feelling of fullness in the soft palate, pharynx or tonsil (wich can be moved towards the midline). It is normal that this tumour is at first thought to be a peritonsillar abscess.
These tumours usually compress the cranial nerves IX to XII causing dysphonia, dysphagia, dysarthria, glossopharyngeal neuralgia and Horner's syndrome. 80% of them are benign, and a half of those are parotid deep lobe tumours and minor salivary glands tumours (mixed tumours, oncocytomas, Warthin's tumours). Less than 1% of mixed tumours of the parotid deep reach the parapharyngeal space trough the stylomandibular tunnel y produce the feeling of a lump in the throat.
20% of the tumours are neurogenic :
- Neuronioma of the vagus nerve or the sympathetic cervical chain.
- Chemodectoma or paraganglioma of the vagus nerve or the carotid bulb.
- Neurofibroma. In a much smaller proportion, there exists a big variety of tumours both benign and malignant located in the parapgaryngeal space.
How are they treated?
They can only be treated through surgery. Depending on the situation and the size of the tumour there are different ways of approaching it. Due to the hardly reachable location of the tumour and its intimate relation with vital structures, it is a highly complex surgery.
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