Surgical access to parapharyngeal space tumours the. The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig. Old text books divided this space into prestyloid and post stymoid compartments. A modified method for locating parapharyngeal space neoplasms on. Parapharyngeal space pps tumors are rare and account for only 0. A rare case of large schwannoma of the parapharyngeal space. Title summary field provided by blackwell north america, inc. The imaging anatomy of the parapharyngeal space pps. Prestyloid muscular compartment medialtonsillar fossa lateralmedial pterygoid contains fat, connective tissue, nodes poststyloid neurovascular compartment carotid sheath cranial nerves ix, x, xi, xii sympathetic chain stylopharyngeal aponeurosis. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Background the pps is defined as the deepest space in the neck and it consists of the pre. Pdf parapharyngeal space is a suprahyoid neck space.
The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. Tumors of parapharyngeal space iowa head and neck protocols. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. It is an inverse triangle where the base is formed by base of skull, while apex is formed by hyoid bone. Its complex location and its relationship to the skull base, to the deep spaces of the neck, and to the neurovascular structures that traverse it are intimidating enough to keep the novice far from it. The parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. An appreciation of the complex anatomy of potential spaces and fascial planes of the neck is vital to understanding lesions and their potential complications. Any information contained in this pdf file is automatically generated from digital. Mathematics a set of elements or points satisfying specified geometric postulates. A combined neurosurgical approach is indicated for tumors.
In view of the above, a careful meticulous dissection is required via a safe approach like the. Treatment of these tumors is surgical through an external neck approach. Anatomy of the parapharyngeal space pps, as depicted by magnetic resonance imaging mri. Of all the parapharyngeal space tumors, 7080 % are benign, and 2030 % are malignant. Anatomic specimens were dissected to define better the fascial layer representing the medial wall of the masticator space. This is because it is a blind space enclosing important neurovascular structures with the tumour occasionally arising from the nerve sheath itself.
Price, 2016bozza, 2009 inverted pyramid space, base centered on small portion of temporal bone, and the apex at the greater cornu of the hyoid bone. Lecturer of surgical oncology national cancer institute,cairoeypt 20 2. Access to the parapharyngeal space is provided by the infratemporal fossa type c or d approaches. The anatomical location of the parapharyngeal space is rather unique. The fascia that separates these two spaces is an ineffectual barrier to the spread of infection. Pdf role of imaging in the diagnosis of parapharyngeal space. The separation of the masticator and parapharyngeal spaces is somewhat ambiguous. The parapharyngeal space pps is one of the most fascinating anatomic areas of the head and neck.
Axial mri sequence illustrating the deep spaces of the head and neck. Most pps tumors are of salivary or neurogenic origin. The surgical access to parapharyngeal space tumours is limited and difficult. Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. The transcervical approach is commonly used for most pps neoplasms. A fascial layer was found extending from the medial pterygoid muscle to the skull base separating the masticator from the parapharyngeal space. The hyoid bone is the main anatomical structure that limits the spread of infection. This article presents the spatial anatomy of the pps and describes the displacement patterns of the pps fat that are essential for accurate diagnosis and appropriate. Its borders include the nasopharynx and oropharynx medially, the masticator space anterolaterally, the deep lobe of the parotid gland posterolaterally, and the retropharyngeal space posteromedially fig. Type c this approach provides access to the sphenoid and maxillary sinuses, the nasopharynx, pterygomaxillary fossa, parapharyngeal space, eustachian tube, intrapetrous carotid artery, and parasellar region.
Even malignant parapharyngeal space tumors can be asymptomatic for a longer time, and even large tumors only produce unspecific symptoms. Organized by regional anatomy, handbook of head and neck imaging, second edition, will be valuable to radiologists, otolaryngologists, and other medical imaging professionals. It consists largely of fat, neurovascular structures, and, in some definitions. Trismus, drooling, dysphagia, and odynophagia also are. This article is within the scope of wikiproject anatomy, a collaborative effort to improve the coverage of anatomy on wikipedia. Parapharyngeal space spatium parapharyngeum is space lateral and dorsolateral to pharynx, medially continues into retropharyngeal space boundaries. May 11, 2020 the fascial spaces are theoretical spaces that are created between the layers of the deep cervical fascia and are filled with loose areolar connective tissue. Anatomy and common pathology of the parapharyngeal space epos. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. Parapharyngeal space synonyms, parapharyngeal space.
Intraoperatively, the mass was noted to be soft, friable, and well encapsulated, and it extended into the parapharyngeal space. Surgical and ct examinations of 104 patients, each of whom presented with a parapharyngeal space mass, has resulted in the development of an updated ct protocol designed to provide a preoperative diagnosis. Parapharyngeal space cysts, besides salivary gland origin may be derived from the first and dorsal portions of the second pharyngeal pouches. Approaches to the parapharyngeal space plastic surgery key. The pharyngeal mucosal, parapharyngeal, and retropharyngeal. After locating the aforementioned anatomic areas on mr images.
Tumors of the parapharyngeal space pps, a potential space lateral to the upper pharynx, are uncommon, comprising less than 1% of all head and neck neoplasms. Separation of the masticator space from the parapharyngeal. New suggested readings have been added to all chapters to refer readers to indepth resources. To describe the imaging features of a variety of disease processes that may occur in the pps.
The patient underwent an urgent transoral excision biopsy of the left parapharyngeal space mass and a bilateral tonsillectomy figure 2. The parapharyngeal space pps is a space in the suprahyoid neck that contains fat and is surrounded by several other spaces defined by the fascial layers of the neck. The term parapharyngeal space is widely used as a synonym of the lateral pharyngeal space, but the definition of the parapharyngeal space remains unclear because. To illustrate the radiological anatomy of the parapharyngeal space pps. The anatomy of the parapharyngeal space is complex and critical. Understanding the anatomy of the parapharyngeal space is important to understand the advantages, limitations, and risks of the different surgical approaches to the parapharyngeal space. Mid this article has been rated as midimportance on the. A dislocated lateral pharyngeal wall with mild inflammatory changes of the oropharyngeal mucosa was observed during. Management of parapharyngeal space cysts the journal of. Characteristics of reported cases of branchial cyst in the parapharyngeal space author age sex treatment magnotti, 1927 1 8 f excision guissani, 1928 2 25 m excision hoogland, 1951 3 69 m aspiration taylor and burwell, 1954 4 53 m aspiration and sclerosant injection 49 m aspiration 54 m aspiration and sclerosant injection mills, 1959 5 52 f. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported. Schwannoma of the parapharyngeal space request pdf. Parapharyngeal definition of parapharyngeal by medical.
Medical definition of parapharyngeal space merriamwebster. Retropharyngeal space an overview sciencedirect topics. The prestyloid compartment contains fat, muscular structures, lymph. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
The retropharyngeal space is continuous laterally with another potential space, the parapharyngeal space. Parapharyngeal space an overview sciencedirect topics. In some sources the lateral pharyngeal space is divided into 2 parts by the fascial condensation called aponeurosis of zuckerkandl and testut, joining the styloid process to the. The anatomy of the parapharyngeal space is described in detail. The schwannoma is the most common neural tumor found in the pps.
The parapharyngeal space pps is a potential space between the skull base above and the hyoid bone below. The displacement patterns of pps fat that are essential for accurate diagnosis and appropriate treatment of pathology arising in this region. The special traits of the presented case included the following. They are mucosal or epithelial lined structures with no external or visceral opening and always present on the lateral aspects of the nasopharyngeal wall. Both benign and malignant tumors may arise from any of the structures contained within the parapharyngeal space pps. Tensorvascular styloid fascia separates parapharyngeal spaces to two compartments. General anatomy regions of human body regions of head deep spaces of face and neck parapharyngeal space. Common differentials of true pps lesions and their imaging features. Anatomical complexity and etiology article pdf available in the medical journal of malaysia 625. Anatomical complexity and etiology med j malaysia vol 62 no 5 december 2007 415 medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. A new case of a branchial cyst of the parapharyngeal space. Anatomy and common pathology of the parapharyngeal space. The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. Synonyms for parapharyngeal space in free thesaurus.
The parapharyngeal space is a potential space occupied by adipose tissue, cranial nerves v, ix, xi, and xii, the deep cervical lymph nodes, and the ascending pharyngeal and maxillary arteries. Within the deep neck are 11 spaces created by planes of greater and lesser resistance between the fascial layers. Parapharyngeal space definition of parapharyngeal space. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours. What is the anatomy of the parapharyngeal space relevant to deep. Prestyloid compartment masticator space fat retromandibular parotid lymph nodes2012. The parapharyngeal space pps is a deep space of the neck shaped as a tilted up pyramid with its.
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