Extracapsular dissection for minimal resection of benign parapharyngeal tumor

Extracapsular dissection (ECD) is thought to be effective in treating benign tumors and minimally invasive. Nonetheless, its application and feasibility in treating benign parapharyngeal space (PPS) tumor, the neoplasm located in the complex anatomical space, have never been investigated. The aim of this study is to evaluate the utility and efficacy of transcervical ECD in treating benign PPS tumors. From 1996 to 2009, 54 patients with PPS tumors were treated by the designated surgeon. Excluding nine patients who were initially regarded as the potential candidates for ECD treatment but failed to meet the inclusion criteria, 22 patients who received the procedure were retrospectively analyzed. In 22 enrolled patients, 10 had pleomorphic adenoma while 6 had neurilemmoma. There were 13 PPS tumors located in the prestyloid space and 9 in the poststyloid space. The median volume of PPS tumors was 22.6 cm³, and the median distance from tumor to skull base was 2.3 cm. The median length of incision was 4.5 cm with the ECD intervention. No major intra- or post-operative complications were noted and post-operative courses were unremarkable in long-term follow-up. This study demonstrates that ECD is an effective and safe treatment for selected benign PPS tumors. It has a favorable clinical outcome and an acceptable aesthetic result, and can be performed in a minimally invasive fashion. Therefore, it is suggested that ECD be included in the treatment modalities of benign PPS tumors.