Transmandibular surgical approach for malignant parapharyngeal space tumors

The parapharyngeal space (PPS) is an inverted cone-shaped fascial space that extends from the skull base down to the level of the hyoid bone. Most tumors of the PPS are benign. Primary malignant tumors of the PPS are rare and include minor salivary gland cancer, malignant peripheral nerve sheath tumors, and malignant paragangliomas. Benign tumors of the PPS can be most often treated surgically by a transcervical or transparotid transcervical approach. A malignant PPS tumor often needs consideration for transmandibular access for adequate exposure and total surgical resection. Preoperative recognition of malignancy using appropriate imaging and, if indicated, tissue diagnosis is therefore pivotal in successful operative planning and oncologic, functional, and cosmetic outcome. Although the transmandibular approach provides excellent access to the PPS, accurate preoperative planning and meticulous surgical technique are crucial for successful outcome after mandibulotomy.