Transoral robotic surgery for prestyloid parapharyngeal space masses

Parapharyngeal space (PPS) tumors can be divided anatomically into two major categories based upon location relative to the styloid process. Prestyloid masses are usually benign salivary gland tumors. Traditionally, these have been removed by transcervical, transparotid, or transmandibular approaches or a combination of these. While transoral removal of prestyloid masses is not a new concept, it has not been popular due to concerns about safety. The introduction of TransOral Robotic Surgery (TORS) has made removal of prestyloid tumors feasible in the majority of patients. Other parapharygeal space tumors can be removed transorally as well. The focus of this article is to describe the technical details of TORS removal of prestyloid parapharyngeal space masses. Careful preoperative assessment and attention to intraoperative technical details are the keys to safe surgery in this area. Very specific indications and contraindications exist for the procedure. Numerous advantages of this approach are detailed. Complications have been minor and very uncommon and easily managed using the techniques described herein.