Endoscope-Assisted Transoral Transpharyngeal Approach to Poststyloid Parapharyngeal Metastasis from Papillary Carcinoma of the Thyroid

Introduction:

Parapharyngeal space (PPS) is a challenging anatomical region, full of neurovascular vital structures. Nevertheless, tumors of this region are uncommon, accounting for 0.5% of all head and neck neoplasms.^1,2 Hence, surgical management of PPS lesions is often arduous even for experienced surgeons. A number of different approaches have been proposed over the years. ¹ Herein, we present an endoscope-assisted transoral transpharyngeal approach (EATTA) ³ performed in a patient with poststyloid parapharyngeal metastasis from papillary thyroid carcinoma.

Materials and Methods:

In October 2015, one patient was admitted for an EATTA for poststyloid parapharyngeal metastasis from papillary thyroid carcinoma in the First ENT Unit of the University of Pisa. Demographic data, clinical presentation, characteristics of the lesion, complications, hospitalization length, and time to oral diet were also collected and discussed. The patient underwent CT scans of the neck pre- and postoperatively. The patient was informed and counseled about the need of conversion to an open approach and a written informed consent was signed up.

Results:

In January 2015, a 38-year-old male was treated for a papillary thyroid carcinoma with total thyroidectomy, dissection of the central and right lateral neck compartments, and adjuvant radioiodine therapy. The patient was asymptomatic and the lesion in the right PPS was identified with a 6-month postoperative control CT scan. The maximum diameter of the metastasis was 20 mm. The procedure lasted 85 minutes. No acute intraoperative complications occurred. No conversion to an external approach was required. No major or minor complications occurred postoperatively as well. At the end of the resection, abdominal fat was used to fill the surgical cavity. Postoperative CT scan showed no remaining lesion or other complications. Hospitalization length was 4 days. The patient was able to feed per os the first day after surgery. No nasogastric feeding tube was required. The patient did not experience velopalatal insufficiency and did not refer to dysphagia during food intake. To date, we observed no disease recurrence.

Conclusions:

This case seems to demonstrate the feasibility and safety of EATTA and we propose this approach as a valuable alternative to external approaches, in properly selected cases. The assistance of the endoscope makes it easier and thus safer for dissection, even though we recommend its use in experienced hands. Obviously, no definitive conclusions about the effectiveness of this procedure can be drawn nor can the oncologic outcome be assessed with one patient and in a short follow-up.

No competing financial interests exist.

Runtime of video: 2 mins 59 secs