Diagnosis and Management of the Incidental Parapharyngeal Space Mass

PROGRAM DESCRIPTION: Parapharyngeal Space Tumors can be a major challenge for Otolaryngologists. We have seen an increase in the number of patients who have tumors that are discovered incidentally, mostly as a result of advanced head and neck imaging for other conditions. While most of these tumors are benign, some of these lesions represent salivary gland malignancy and most tumors in this area require additional evaluation and management by Otolaryngologists. Understanding the workup and management parapharyngeal space lesions is a fundamental core knowledge for all otolaryngologists. This case-based panel will provide important guidance to the clinical evaluation of patients with such tumors including the role of imaging and biopsy in predicting the risk of malignancy and determine the role of surgery or other diagnostic studies and treatments. Surgery is often but not always required for parapharyngeal space tumors, and the approach is dependent on the nature of the tumor. Prestyloid tumors are usually minor salivary gland origin but may involve the deep lobe of the parotid gland. Poststyloid lesions are usually paraganglioma. Nerve sheath tumors and less common neoplasms may present in either compartment and there are some lesions that overlap with other compartments. The primary modality of treatment is surgery for many of these tumors but tailoring the surgery to the pathology and extent of disease is important to avoid unnecessary morbidity. The role of ultrasound and cross-sectional imaging, especially MRI and the indications for preoperative biopsy and other adjunctive measures such as embolization will be detailed. Approaches and nuances in minimally invasive surgery to avoid complications and important aspects of patient counseling will be discussed. In addition, the panel will address the approach to suspected or proven malignancy as well as the discovery of malignancy or other unexpected findings at the time of surgery or final pathology.

OUTCOME OBJECTIVE 1: Classify Parapharyngeal tumors by location on imaging evaluation and by expected histological type.

OUTCOME OBJECTIVE 2: Order appropriate additional testing and determine the need for additional treatment or consultation.

OUTCOME OBJECTIVE 3: Counsel patients on the incidental parapharyngeal tumor and its further diagnostic evaluation and management

BACKGROUND STATEMENT: We are seeing more and more of these tumors as head and neck surgeons and we believe it is important to educate the comprehensive/general otolaryngologist about how these are handled so they can determine next steps and refer patients to specialists depending on the situation.