Article: Combined Endonasal-Transcervical Approach to a Metastatic Parapharyngeal Space Papillary Thyroid Carcinoma

Purpose: Although papillary thyroid carcinoma metastases to the parapharyngeal space are rare, the high amount of fat tissue allows tumors to grow clinically undetectable until they invade most of the parapharyngeal space. We describe for the first time a combined endonasal and transcervical approach for a parapharyngeal metastasis from a papillary thyroid carcinoma.

Materials And Methods: A 51-year-old male with a previous history of papillary thyroid carcinoma presented with left ear fullness and left-sided facial numbness. Imaging revealed a 4x3 cm pre-styloid parapharyngeal space mass invading the foramen ovale and extending below the palate. Needle biopsy confirmed metastatic papillary thyroid carcinoma.

Results: The lesion was resected with a combined endoscopic endonasal and transcervical approach. Postoperative MRI revealed gross total resection, and the patient recovered from his symptoms.

Conclusion: This novel approach provides access to pre-styloid parapharyngeal tumors with superior extension to the skull base, avoiding more extensive traditional open approaches.

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References

1.

Desuter G, Lonneux M, Plouin-Gaudon I, Jamar F, Coche E, Weynand B . Parapharyngeal metastases from thyroid cancer. Eur J Surg Oncol. 2004; 30(1):80-4. DOI: 10.1016/j.ejso.2003.10.004. View

2.

Battaglia P, Turri-Zanoni M, Dallan I, Gallo S, Sica E, Padoan G . Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors. Otolaryngol Head Neck Surg. 2014; 150(4):696-702. DOI: 10.1177/0194599813520290. View

3.

Chang S, Goldenberg D, Koch W . Transcervical approach to benign parapharyngeal space tumors. Ann Otol Rhinol Laryngol. 2012; 121(9):620-4. DOI: 10.1177/000348941212100910. View

4.

Bozza F, Vigili M, Ruscito P, Marzetti A, Marzetti F . Surgical management of parapharyngeal space tumours: results of 10-year follow-up. Acta Otorhinolaryngol Ital. 2009; 29(1):10-5. PMC: 2689563. View

5.

Terre Falcon R, Rivera-Serrano C, Miranda J, Prevedello D, Snyderman C, Kassam A . Endoscopic endonasal dissection of the infratemporal fossa: Anatomic relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope. 2010; 121(1):31-41. DOI: 10.1002/lary.21341. View

6.

Kanzaki S, Nameki H . Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images. J Laryngol Otol. 2007; 122(6):628-34. DOI: 10.1017/S0022215107009875. View

7.

Dallan I, Lenzi R, Bignami M, Battaglia P, Sellari-Franceschini S, Muscatello L . Endoscopic transnasal anatomy of the infratemporal fossa and upper parapharyngeal regions: correlations with traditional perspectives and surgical implications. Minim Invasive Neurosurg. 2011; 53(5-6):261-9. DOI: 10.1055/s-0030-1263105. View

8.

Wang X, Xu Z, Wu Y, Liu S, Yu Y . Surgical management of parapharyngeal lymph node metastasis of thyroid carcinoma: a retrospective study of 25 patients. Chin Med J (Engl). 2012; 125(20):3635-9. View

9.

Rompaey J, Suruliraj A, Carrau R, Panizza B, Solares C . Access to the parapharyngeal space: an anatomical study comparing the endoscopic and open approaches. Laryngoscope. 2013; 123(10):2378-82. DOI: 10.1002/lary.24121. View

10.

El-Sayed I, Pletcher S, Russell M, McDermott M, Parsa A . Endoscopic anterior maxillotomy: infratemporal fossa via transnasal approach. Laryngoscope. 2011; 121(4):694-8. DOI: 10.1002/lary.21469. View

11.

Riffat F, Dwivedi R, Palme C, Fish B, Jani P . A systematic review of 1143 parapharyngeal space tumors reported over 20 years. Oral Oncol. 2014; 50(5):421-30. DOI: 10.1016/j.oraloncology.2014.02.007. View