title: Endoscopic-assisted transoral-transpharyngeal approach to parapharyngeal space and infratemporal fossa: focus on feasibility and lessons learned.
abstract: The parapharyngeal space (PPS) is a challenging anatomical region, rich in vascular and nervous vital structures. Surgery is considered the treatment of choice for the majority of PPS lesions. Herein, we present a retrospective evaluation on ten patients with various types of lesions of the parapharyngeal and infratemporal fossa (ITF) regions operated on via an endoscopic-assisted transoral-transpharyngeal approach (EATTA), focusing on feasibility and safety. A retrospective evaluation of patients treated by means of EATTA to PPS and/or ITF lesions was carried out. The clinical records of patients who were operated on with EATTA for PPS and/or ITF lesions between March 2009 and October 2015 at two referral centres were reviewed and the intra-operative and post-operative complications were analysed. Ten patients who underwent EATTA on the PPS and ITF were included in this series. The procedure was performed in six patients for tumour removal, in three patients for diagnostic purposes and in one patient for pain control. No major complications occurred. No conversion to external approach was required. We observed only two minor complications which were promptly solved. No dysphagia or other problems during the food intake were observed in our series. One day after surgery all patients, except one, referred a value of VAS minor than 4. To date, no evidence of disease recurrence has been assessed in all six oncological cases. Although preliminary, our experience seems to demonstrate the feasibility and safety of EATTA when properly planned and performed.
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, Italy.|Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), University of Insubria, Varese, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Dallan
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, Italy. g.fiacchini@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Fiacchini
authors.affiliation: Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), University of Insubria, Varese, Italy.|Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Turri-Zanoni
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Seccia
authors.affiliation: Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), University of Insubria, Varese, Italy.|Unit of Otorhinolaryngology, Department of Biotechnology and Life Sciences (DBSV), Azienda Ospedaliero-Universitaria Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Battaglia
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, Italy.
authors.forename: Augusto Pietro
authors.initials: AP
authors.lastname: Casani
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, Italy.
authors.forename: Lodovica
authors.initials: L
authors.lastname: Cristofani-Mencacci
authors.affiliation: First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124, Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sellari-Franceschini
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009960:Oropharynx; D010614:Pharynx / Q000601:surgery*; D011183:Postoperative Complications; D011626:Pterygoid Muscles / Q000601:surgery; D012189:Retrospective Studies
keywords: Endoscopic approach; Infratemporal fossa; Parapharyngeal metastasis; Parapharyngeal space; Transoral surgery