Neurogenic tumors of parapharyngeal space – Clinical evaluation and management: Our experience

Context: Neurogenic tumors are the second most common parapharyngeal space (PPS) lesions, with schwannoma being the most common neurogenic tumor seen. PPS tumors account for 0.5% of all head-and-neck masses, and most surgeons might not encounter it in their lifetime. Anatomical complexity and histological diversity of PPS pose various diagnostic and treatment challenges. Relevant literature about lesions of this space is growing but is still limited. Aims: The aim of our study was to evaluate neurogenic tumors of PPS and their management over a period of 5 years. Settings and Design: A retrospective study was conducted in our institution for a duration of 5 years from January 2014 to December 2018. Materials and Methods: Clinical features were analyzed. All patients were subjected to radio imaging-contrast-enhanced computerized tomography and contrast magnetic resonance imaging, and findings were noted. After imaging, patients were subject to fine-needle aspiration cytology. Transcervical approach was used for 11 cases and endoscopic-assisted transoral transpharyngeal approach (EATA) used for 4 cases. Results: A total of 27 patients with PPS tumors were evaluated and treated. The incidence of neurogenic tumors was 55.5% (15 cases). Out of the 15 patients with neurogenic tumors, 11 cases were schwannomas, 1 case was vagal neurofibroma, and 3 cases were paragangliomas from the carotid body. Conclusions: Neurogenic tumors of PPS are more common than traditionally thought. Neck swellings and oropharyngeal masses are the most common presenting features. FNAC is a very useful tool to establish a preoperative cytological diagnosis. Both external approach and EATA are effective approaches, provided that careful patient selection is done.