[Imaging of the Parapharyngeal Space Tumors and Selection of the Treatment]

To analyze the imaging features of parapharyngeal space tumors, and to guide the choice of treatment. A retrospective analysis of 75 cases' clinical data of parapharyngeal space tumor was carried out. All patients underwent enhanced CT and/or enhanced MRI, those tumors closely related to blood vessels and vascular tumors were examined by CTA or MRA, those closely related to peripheral nerves were examined by MRN. We evaluated the relationship between tumor and carotid sheath, parotid gland, skull base and hard palate. We choose the treatment according to the imaging features. Imaging revealed 69 benign tumors and 6 malignant tumors. 8 benign tumors chose to follow up, 61 benign tumors and 6 malignant tumors underwent surgery. Among them, 17 cases of tumors were operated by the transoral approach assisted by endoscope, which were located in the medial of carotid sheath, with the main body protruding toward the oropharynx, below the level of the hard palate, and more than 5 mm away from the skull base; 31 cases were resected by the transcervical approach, and the tumor body protruded toward the neck（15 cases were lateral of the carotid sheath, and 16 cases were medial）; 16 cases were resected by the transparotid approach, and the tumor harbored a broad interconnecting margin with the parotid gland; there were 3 cases of other approaches（1 case of transnasal approach, 1 case of combined transnasal and transcervical approach, and 1 case of combined transauricular-cervical approach）. Postoperative complications occurred in 25 patients, including 9 cases of facial paralysis（6 cases of grade Ⅱ, 2 cases of grade Ⅲ, 1 case of grade Ⅳ）, 1 case of facial numbness, 5 cases of Hornor's syndrome; tongue extension deflection in 3 cases, 2 cases cough while drinking water, 1 case of postoperative hematoma formation, 1 case of oral errhysis, hearing loss in 1 case, shoulder shrugging and hand lifting weakness in 1 case, salivary fistula in 1 case, tracheotomy was performed in 1 case because of postoperative oropharyngeal swelling, swallowing obstruction in 1 case, gustatory sweating syndrome in 1 case and acute cerebral infarction was caused by thrombus detachment in 1 case. Imaging results are important basis for the treatment of parapharyngeal space tumors. The choice of surgical approach should be made based on imaging, including the relationship with the big vessels of the neck, the parotid gland, the hard palate, and the distance from the skull base, combined with the nature of the tumor.