Parapharyngeal space and infratemporal fossa are 2 overlapping spaces in head and neck which have complex anatomy with vital neurovascular structures passing through them. Tumors of this region are extremely rare but majority of them (80%) are benign. Benign tumors of this region can lead to swellings in facial region, neck and oropharynx. Dysphagia may be a complaint of the patient. Many of these tumors have malignant potential. Removal of these tumors requires a good understanding of the anatomy of this space so that correct surgical approach can be selected. The surgeon needs to be adept in using the most suitable surgical approach for excision of these tumors. There are various approaches which can be used to access these deeply seated tumors but the issue of prime importance is selecting the appropriate approach for the various tumors here based on their size and their exact location in this complex anatomical space. Inappropriate approach can lead to inadequate tumor excision and can lead to injuries to the neurovascular structures in this region which can cause significant disability. The case series reported here describes the various approaches to this region and highlights the importance of correct selection of the surgical approach.

Desmoid fibromatosis (DF) arising from musculoaponeurotic structures rarely affects the head and neck region with the abdomen being the most common site of origin. These are benign tumors with locally infiltrative nature usually presenting as painless swellings that are rapidly growing. The infratemporal fossa DF is an extremely rare location with few clinical reports. This article discusses the management of a 2-year-old child with DF of the infratemporal fossa (ITF) along with literature review.

UNASSIGNED: The objective of this study was to assess the accessibility in the resection of maxillary tumours, resection margin status, and morbidity following maxillectomy through lip split with paramedian mandibulotomy approach.
UNASSIGNED: A retrospective review of 20 consecutive patients who underwent maxillectomy with resection of primary tumours through lip split mandibulotomy approach with supraomohyoid neck dissection for maxillary tumours between 2008 and 2016. Patients details including the tumours site, extension and neck node involvement. were recorded. Resection technique, status of surgical resected margins was also discussed. Disease status was obtained from patients follow up records. Morbidity was assessed at mandibulotomy site in terms of infection, osteotomy healing, neural disturbance and mouth opening. The institutional research committee approval was taken for this study.
UNASSIGNED: All patients underwent adequate en bloc resection of the tumours, except in two patients in whom superior margins was positive. Osteotomy site healed well in our all patients except in one patient in whom there was infection at the osteotomy site during post radiation therapy. Minimal neural morbidity was encountered in four patients (three patients had lingual nerve hypothesia and two patients had inferior alveolar nerve hypothesia) which recovered in all four patients, over the 6th month post-operative period. Post-operative interincisal distance was satisfactory with a mean of 30.5 mm.
UNASSIGNED: Mandibulotomy with lip split is considered to be an ideal approach to access tumours of maxilla and its adjacent structures, SOHND with level III clearance. This approach provide excellent accessibility for en bloc resection of operable maxillary tumours with good outcome of resultant scar and minimal morbidity.

The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.
Scopo del presente studio è di descrivere la nostra esperienza riguardo i tumori benigni della regione parafaringea sottoposti a resezione chirurgica per via transcervicale senza mandibulotomia e valutarne le complicanze post-operatorie. Questo studio analizza retrospettivamente una serie di 44 pazienti sottoposti ad intervento chirurgico per tumori benigni della regione parafaringea nell\'arco temporale di 10 anni. La diagnosi è stata formulata in tutti i pazienti sulla base dei dati clinici e radiologici; in nessun caso è stato utilizzato lo studio citologico su agoaspirato (FNAB). In tutti i casi l\'approccio di scelta alla neoformazione è stato quello transcervicale. In 5 pazienti è stato necessario un allargamento alla regione parotidea per via della localizzazione anatomica della lesione. I tumori sono stati classificati radiologicamente in post-stiloidei in 27 casi e in prestiloidei in 17 casi. La diagnosi istopatologica definitiva è risultata in 16 casi di paraganglioma vagale, in 13 casi di adenoma pleomorfo, in 10 casi di schwannoma e di tumori relativamente rari nei rimanenti 5 casi. In tre pazienti è stata osservata paralisi di nervi cranici nel pre-operatorio. Paralisi permanente di nervi cranici è stata osservata in 19 casi (43.2%) nel post-operatorio, nella maggioranza di casi si trattava di tumori neurogenici quali paragangliomi del vago (n:16) e schwannoma (n:2) e in un caso di tumore non-neurogenico della regione parafaringea. Il periodo medio di follow up è stato di 61 mesi (SD +/- 33.10) e in questo lasso di tempo non sono state osservate recidive locali di malattia in nessun paziente. L\'approccio per via transcervicale dovrebbe costituire il trattamento chirurgico di prima scelta nei tumori della regione parafaringea eccezion fatta per le forme ricorrenti o maligne. I vantaggi sono legati all\'accesso diretto alla regione parafaringea, adeguata esposizione chirurgica delle strutture neurovascolari del collo, miglior risultato estetico associato al mantenimento della continuità della mandibola e ridotte morbidità ed ospedalizzazione.