title: From transmandibular to transoral robotic approach for parapharyngeal space tumors.
abstract: OBJECTIVE
  Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor's radiological and clinical characteristics.
  
  
  METHODS
  Critical retrospective analysis of patients with PPS neoplasms who underwent surgery at our Institute. Data were collected on patient age and sex, tumor location and size, preoperative investigations, surgical approaches, histopathology, complications and outcomes.
  
  
  RESULTS
  Between January 2000 and July 2015, 53 patients were treated at our Institute. Salivary gland tumors were the most common neoplasms followed by neurogenic tumors. CT scan/MRI were the most used preoperative imaging studies. The cervical approach with or without parotidectomy is the most used, providing the best compromise between the need for radicality and low risk of damage to the neurovascular structures. Mandibulotomy is used whenever the mass extends to the cranial base, assuming a higher morbidity, a slower functional recovery and the need for tracheotomy. Recently, TORS has been used for tumors of the PPS with promising outcomes.
  
  
  CONCLUSIONS
  PPS surgery includes a wide spectrum of approaches but it is still a matter of debate which one guarantees better functional and oncological outcomes. We report a surgical algorithm based on surgical invasiveness and tumor characteristics to standardize PPS tumors management. We also highlight the upcoming role of TORS in this field.
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Chu
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Tagliabue
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Giugliano
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Calabrese
authors.affiliation: Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia - National Center of Oncological Hadrontherapy (CNAO Foundation), Str. Privata Campeggi, 53, 27100 Pavia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Preda
authors.affiliation: Department of Head and Neck Surgery and Otorhinolaryngology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Electronic address: mohssen.ansarin@ieo.it.
authors.forename: Mohssen
authors.initials: M
authors.lastname: Ansarin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010610:Pharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D012468:Salivary Gland Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult