title: Combined Endonasal-Transcervical Approach to a Metastatic Parapharyngeal Space Papillary Thyroid Carcinoma.
abstract: OBJECTIVE
  Although papillary thyroid carcinoma metastases to the parapharyngeal space are rare, the high amount of fat tissue allows tumors to grow clinically undetectable until they invade most of the parapharyngeal space. We describe for the first time a combined endonasal and transcervical approach for a parapharyngeal metastasis from a papillary thyroid carcinoma.
  
  
  METHODS
  A 51-year-old male with a previous history of papillary thyroid carcinoma presented with left ear fullness and left-sided facial numbness. Imaging revealed a 4x3 cm pre-styloid parapharyngeal space mass invading the foramen ovale and extending below the palate. Needle biopsy confirmed metastatic papillary thyroid carcinoma.
  
  
  RESULTS
  The lesion was resected with a combined endoscopic endonasal and transcervical approach. Postoperative MRI revealed gross total resection, and the patient recovered from his symptoms.
  
  
  CONCLUSIONS
  This novel approach provides access to pre-styloid parapharyngeal tumors with superior extension to the skull base, avoiding more extensive traditional open approaches.
authors.affiliation: Department of Otolaryngology-Head and Neck surgery. Department of Neurosurgery, University of California San Francisco.
authors.forename: Arnau
authors.initials: A
authors.lastname: Benet
authors.affiliation: Neurosurgery, Hospital Universitario de Canarias.
authors.forename: Julio
authors.initials: J
authors.lastname: Plata Bello
authors.affiliation: Otolaryngology Head and Neck Surgery, University of California San Francisco.
authors.forename: Ivan
authors.initials: I
authors.lastname: El-Sayed
keywords: endoscopic endonasal; papillary thyroid carcinoma; parapharyngeal space; transcervical; transmaxillary-transpterygoid