A thorough understanding of transoral anatomy is crucial to perform transoral robotic surgery safely and efficiently. The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck. The patient was a 32 yr old male with chief complaints of difficulty in swallowing and swelling in the neck since last 4 years.
Request pdf surgical anatomy of the parapharyngeal space. Contents fat main component trigeminal nerve cn v internal maxillary artery ascending pharyngeal artery pterygoid venous plexus only. Common differentials of true pps lesions and their imaging features. An appreciation of the complex anatomy of potential spaces and fascial planes of the neck is vital to understanding lesions and their potential complications. The parapharyngeal space ps is defined as the deepest space in the neck and it consists of the pre and poststyloid regions. These lesions could be classified as being either hypervascular glomus tumors or metastatic kidney, thyroid, or venous hemangiomas or hypovascular salivary gland tumors, neurogenic tumors, lymphomas, sarcomas. The chinese visible human data set can provide complete and accurate data. Find out what nerves are found in the parapharyngeal space on the full. A variety of tumor types can develop in this location.
Bs buccal space, ica internal carotid artery, ijv internal jugular vein, ms masticator space, pms pharyngeal mucosal space, pps parapharyngeal space, ps parotid space, pvs prevertebral space, rps retropharyngeal space, sms submandibular space, t torus tubarius. Parapharyngeal space tumors are rare and account for 0. The anatomy of the pps is responsible for a wide variety of tumors arising from the pps. A midline raphe is present in this space making some infections appear unilateral. Laterally, the parapharyngeal space an inverted pyramid lateral to the pharyngeal constrictors between the base of skull and the hyoid cornu contains the pterygoid muscles, branches of the trigeminal nerve, and the internal maxillary vasculature. Anatomical complexity and etiology article pdf available in the medical journal of malaysia 625. Any information contained in this pdf file is automatically generated from digital. Parapharyngeal space spatium parapharyngeum is space lateral and dorsolateral to pharynx, medially continues into retropharyngeal space boundaries. However without treatment infections can easily spread from one space to the adjacent space. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. Apr 02, 2017 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. Pdf vagal schwannoma in parapharyngeal space anatomical.
The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. Both benign and malignant tumors may arise from any of the structures contained within the parapharyngeal space pps. Outline anatomy pathology clinical evaluation imaging with ct, mri, angiography2012 surgical treatment. Infratemporal fossa, masticator space and parapharyngeal. Anatomy of the parapharyngeal space pps, as depicted.
We report a case each of these deep neck space abscesses to highlight their difference with emphasis on its anatomy and possible etiologies. The poststyloid compartment contains the carotid sheath and cervical sympathetic chain. A determination of the optimal approach to the parapharyngeal space, known as surgical access is most often performed through a standard parotid approach. The parapharyngeal space also termed the lateral pharyngeal space or prestyloid parapharyngeal space, shaped like a cone or a pyramid, inverted with its base at the sphenoid bone, with its apex inferiorly pointing to the greater cornu of the hyoid bone. Anatomy and common pathology of the parapharyngeal space. The diagnosis of tumor in this space is essentially made by understanding the anatomy of this space. Parapharyngeal dissection for papillary thyroid cancer. Mar 23, 2020 the parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. The parapharyngeal space is one of the deep compartments of the head and. The parapharyngeal space is shaped like an inverted pyramid, with its base at the skull base, with its apex inferiorly pointing towards the greater. This anatomic distinction is significant as the contents of each compartment determine the possible histologic etiologies of lesions in the parapharyngeal space. 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.
Article information, pdf download for roof of the parapharyngeal space. Mostly these cysts arise from second branchial cleft and occur in the neck, anterior to the sternocleidomastoid muscle at the mandibular angle. Imaging of parapharyngeal space lesions focus on the prestyloid compartment ji hoon shin 1, ho kyu lee 1, sang yoon kim 2, choong gon choi 1 and dae chul suh 1. Ethical approval this article does not contain any studies with human. A stepbystep logical approach with surgical considerations. To allow better visualization and increased triangulation of a bimanual dissection technique, a sublabial canine fossa antrostomy was created. A definite posterior marginal fascia of the space was seen along the anterior aspect of the stylopharyngeus and styloglossus muscles. Sep 05, 2019 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. Parapharyngeal space an overview sciencedirect topics. Access to parapharyngeal space vula university of cape town.
Menachem gross, ron eliashar, in orofacial pain and headache, 2008. Trismus, drooling, dysphagia, and odynophagia also are. Management of parapharyngeal and retropharyngeal space infections. A histological study using latestage human fetuses article in surgical and radiologic anatomy may 2012 with 44 reads how we measure reads. To illustrate the radiological anatomy of the parapharyngeal space pps. Separation of the masticator space from the parapharyngeal space. It can be split into the retropharyngeal space and the parapharyngeal space.
It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of. Van rompaey j1, suruliraj a, carrau r, panizza b, solares ca. The new protocol divided the pps into three compartments. The differential diagnoses of an abscess deep in the neck are retropharyngeal abscess and parapharyngeal abscess. Retropharyngeal and parapharyngeal abscess retropharyngeal abscess background 1. Using semiserial sagittal sections of 15 latestage human fetal heads, we studied details of the topographical anatomy. The displacement patterns of pps fat that are essential for accurate diagnosis and appropriate treatment of pathology arising in this region. If more than half of the size of the c2 vertebra, it may indicate retropharyngeal abscess. The styloid fascia further divides the parapharyngeal space into an anterolateral prestyloid compartment, and a posteromedial poststyloid compartment. Anatomic specimens were dissected to define better the fascial layer representing the medial wall of the masticator space. Although the prestyloid space is well known, its definition still remains unclear. This is part of the throat and, by extension, the digestive system. Deep neck space infections involving the parapharyngeal space ppsor retropharyngeal space rps are potentially lifethreatening conditions. Find out what nerves are found in the parapharyngeal space on the full version of this video.
It consists largely of fat, neurovascular structures, and, in some definitions, the retromandibular part of the deep lobe of the parotid gland. 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. Histopathologic classification of parapharyngeal space tumors. Pdf background tumors of the parapharyngeal space pps are rare. Trismus, drooling, dysphagia, and odynophagia also are observed commonly. Parapharyngeal space radiology reference article radiopaedia. An objective description of advantages and limitations of the. General anatomy regions of human body regions of head deep spaces of face and neck parapharyngeal space. Benign and malignant tumors can arise from any of the structures contained within the parapharyngeal space. Visualization of the parapharyngeal space of the chinese. It occupies the space between muscles of mastication and the muscles of deglutition. The parapharyngeal space has also been referred to in the literature as the lateral pharyngeal, peripharyngeal, pharyngomaxillary, pterygopharyngeal, pterygomandibular, and pharyngomasticatory space, and its boundaries have been described with more variation than those of any other space of the neck. Branchial cleft cysts extending to the lateral wall of the pharynx are rare. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck.
The parapharyngeal space is a deep potential neck space, with inverted pyramid in shape and extends. A bluish cyst was seen anterior to the anterior pillar of left tonsil. Locketz gd, horowitz g, abughanem s, wasserzug o, abergel a, yehuda m, fliss dm. The parapharyngeal space pps is an inverted pyramidshaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyngeal invasion, and lymphomas, can be found in this space. The pps is an inverted pyramid with its base against the skull base and its apex. Contemporary management of primary parapharyngeal space. Transoral surgical anatomy and clinical considerations of. Suprahyoid neck fascial configuration, especially in the. The imaging anatomy of the parapharyngeal space pps. The involvement of the parapharyngeal space pps and the retropharyngeal space rps poses significant diagnostic and therapeutic problems. Transoral endoscopic anatomy of the parapharyngeal space. The international federation of head and neck oncologic societiescurrent concepts in head and neck surgery and oncology 2012 parapharyngeal space tumors jatin p. It consists largely of fat, neurovascular structures, and, in some definitions, the.
Welcome to our introductory tutorial on the blood vessels of the pharyngeal space. Anatomy and common pathology of the parapharyngeal space epos. Parapharyngeal space article about parapharyngeal space by. Abstract background several surgical approaches to the parapharyngeal space pps have been proposed. The digitized model of the parapharyngeal space and its surroundings offer unique insights into the complex anatomy, and provide morphological data for image diagnosis and operation of the parapharyngeal space. When dynamic scanning is used, diagnostic angiography or digital venous imaging dvi can be avoided in almost all of these cases. Transcervical excision of parapharyngeal and retropharyngeal lymph nodes requires a thorough understanding of the anatomy of the neck and parapharyngeal space, along with a stepwise surgical technique to safely expose the parapharyngeal space. An objective description of advantages and limitations of the surgical routes is lacking. 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. The parapharyngeal space is a potential space in the head and the neck. The parapharyngeal space is one of three potential spaces that can cause deep neck space infections retrophanygeal space. Retropharyngeal space infections that are close to the skull base often require a.
A detailed understanding of the anatomy of the neck and the propagation of infection between neck spaces is imperative when formulating a safe and successful treatment plan. 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. Tumors of parapharyngeal space iowa head and neck protocols. The parapharyngeal space was accessed endonasally by removal of the medial and posterior walls of the maxillary sinus. The prevertebral fascia covered the longus colli, longus capitis, and rectus capitis lateralis muscles, but was most evident along the longus colli muscle. The parapharyngeal space, is a potential space in the head and the neck. To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. The separation of the masticator and parapharyngeal spaces is somewhat ambiguous. It is an inverse triangle where the base is formed by base of skull, while apex is formed by hyoid bone. Ms is a fascial lined space containing all four masticator muscles, the posterior body and ramus of mandible and the mandibular nerve. This video is about the retropharyngeal space, its boundaries, contents, applied anatomy in detail. Parapharyngeal space definition of parapharyngeal space by.
The lateral pharyngeal space is shaped like a cone or a pyramid, inverted with its base at the sphenoid bone, with its apex inferiorly pointing to the greater cornu of the hyoid bone. Infections arise from foci in the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses. Due to the complexity of the anatomy of the parapharyngeal space, which contains the carotid artery and numerous cranial nerves, surgical planning is vital. Parapharyngeal space medical definition merriamwebster. Jul 04, 2016 the prestyloid space contains the deep lobe of the parotid, minor salivary gland, parapharyngeal fat pad, and few lymph nodes. A fascial layer was found extending from the medial pterygoid muscle to the skull base separating the masticator from the parapharyngeal space. Parapharyngeal space tumors institute for head, neck and. Contents fat main component trigeminal nerve cn v internal maxillary artery ascending pharyngeal artery. Parapharyngeal space the parapharyngeal space is shaped like a pyramid, inverted with its base at the skull base, with its apex inferiorly pointing to the greater cornu of the hyoid bone. Multiperspective, quantificationbased study background several surgical approaches to the. 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. Prestyloid compartment of the parapharyngeal space. Anatomical relations of presty loid pps and contralateral pleomorphic adenoma, to medial pterygoid, submandi bular salivary gland, and hyoid bone. A benign, mature, parapharyngeal teratoma presenting in an.
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. This fascial space is also known as the lateral pharyngeal space. An eight year old female child presented with a cystic swelling in the left parotid region. Inferiorly, the prestyloid space faced the bucallis and. Ct scan showed the cyst extending into left parapharyngeal space. Parapharyngeal space anatomy cummings refers to the pps also as the lateral pharyngeal or pharyngomaxillary space. Branchial cleft cysts are the most common neck masses in adults. Background the pps is defined as the deepest space in the neck and it consists of the pre. Infection can spread to mediastinum and cause necrotizing mediastinitis pathophysiology 1. Also, malignant tumors from adjacent areas eg, the pharynx can extend into the parapharyngeal space by direct growth, or distant tumors may metastasize to the lymphatics within the space. Bony anatomy around the space includes the skull base superiorly, and the greater cornu or greater horns of the hyoid. The fascial configuration in the suprahyoid parapharyngeal space was evaluated using semiserial sagittal sections of 15 late.
Schwannoma is a rare tumor in the parapharyngeal space. Malignant peripheral nerve sheath tumor in the parapharyngeal space. Tumors of the parapharyngeal space pps are rare, accounting for 0. The roof of the parapharyngeal space pps is poorly defined. To describe the imaging features of a variety of disease processes that may occur in the pps. Pdf transoral endoscopic anatomy of the parapharyngeal.
It is classed as one of the suprahyoid fascial spaces because it is situated on the lateral aspect of the pharynx and is continuous with the retropharyngeal space posteriorly and the submandibular space anteriorly. Ps tumors originating in these regions are thought to dislocate the. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. It is an inverted coneshaped potential space that extends from the hyoid bone to. The parapharyngeal space or lateral pharyngeal or pharyngomaxillary space is in the upper neck above the hyoid bone. May 11, 2012 although the prestyloid space is well known, its definition still remains unclear. It is an inverted coneshaped potential space that extends from the hyoid bone to the base of the skull. Salivary gland neoplasms benign to malignant ratio 3. The parapharyngeal space is a complex anatomical area. Click image to view full screen 1 of 2 lateral to the pharynx in the parapharyngeal space, identify the. To understand insideout anatomy of base of tongue, lateral oropharyngeal wall, and parapharyngeal space, cadaveric dissection is highly beneficial and may help to shorten the learning curve for transoral robotic dissections. Management of tumors of the parapharyngeal space cancer network.
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