The transcervical–transparotid corridor for management of parapharyngeal space neoplasms: strengths and limits in a bi-institutional retrospective series

Background and purpose: Parapharyngeal space (PPS) neoplasms represent 1% of all head and neck tumors and are mostly benign. Surgery is the mainstay of treatment and the transcervical–transparotid (TC–TP) corridor still represents the workhorse for adequate PPS exposure. Our series investigates strengths and limits of this approach on a multi-institutional basis. Methods: We reviewed consecutive patients submitted to PPS surgery via TC–TP route between 2010 and 2020. Hospital stay, early and long-term complications, and disease status were assessed. Results: One hundred and twenty nine patients were enrolled. Most tumors were benign (79.8%) and involved the prestyloid space (83.7%); the median largest diameter was 4.0 cm. The TC–TP corridor was used in 70.5% of patients, while a pure TC route in about a quarter of cases. Early postoperative VII CN palsy was evident in 32.3% of patients, while X CN deficit in 9.4%. The long-term morbidity rate was 34.1%, with persistent CN impairment detectable in 26.4% of patients: carotid space location, lesion diameter and malignant histology were the main independent predictors of morbidity. A recurrence occurred in 12 patients (9.4%). Conclusions: The TC–TP corridor represents the benchmark for surgical management of most of PPS neoplasms, though substantial morbidity can still be expected.