Endoscopy-assisted transoral resection of a parapharyngeal space schwannoma without mandibular dissection |
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| Authors: | Keisuke Yamamoto Makoto Kurose Risa Yadomura Ryoto Yajima Tsuyoshi Okuni Kenichi Takano |
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| Affiliation: | 1. Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea;2. Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania;3. Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea;1. Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;2. Department of Otolaryngology - Head and Neck Surgery, Shizuoka City Hospital, 10-93 Ohte-machi, Aoi-ku, Shizuoka, 420-8630, Japan;3. Department of Otolaryngology - Head and Neck Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 420-8527, Japan;1. Department of Otorhinolaryngology, Japanese Red Cross Asahikawa Hospital, Hokkaido, Japan;2. Department of Otorhinolaryngology and Good Sleep Centre, Nagoya City University Graduate School of Medicine, Aichi, Japan;1. Department of Medical Technology, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie 516-8512, Japan;2. Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa 920-0942, Japan;3. Department of Radiation Oncology, Ise Red Cross Hospital, 1-471-2 Funae, Ise, Mie 516-8512, Japan;4. Department of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8131, Japan;5. Proton Therapy Center, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, Fukui 910-8526, Japan;6. Department of Oral Maxillofacial Surgery, The Nippon Dental University Niigata Hospital, 1-8 Hamaura-cho, Niigata, Niigata 951-8151, Japan;7. Department of Oral Health, Faculty of Health and Medical Sciences, Meikai University, 1 Meikai, Urayasu, Chiba 279-8550, Japan |
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| Abstract: | Of the schwannomas that arise from the parapharyngeal space, those in the high cervical region are particularly invasive, requiring mandibular dissection. Because these tumors are benign, however, excessive surgical invasion and postoperative neurological complications should be avoided. Postoperative dropout symptoms may be avoided by intracapsular extraction, including nerve integrity monitoring (NIM) and narrow-band imaging (NBI). Video laryngoscopy surgery is reported to be useful for transoral resection of pharyngeal and laryngeal tumors. This report describes the transoral removal of a giant schwannoma located in the high cervical region from a 74-years-old man using a surgical support device without mandibular dissection.The tumor was located on the right lateral pharyngeal wall and extended from the upper oropharynx to the hypopharynx while compressing the epiglottis to the skull base. No separation was observed between the internal jugular vein and the internal carotid artery. The tumor was diagnosed as a schwannoma with no malignancy on the basis of the histology of a core needle biopsy (CNB), and was completely and safely removed endoscopically using NIM and NBI, with no need for an external incision or mandibular dissection. This case illustrates that even a huge sympathetic schwannoma located in the parapharyngeal space at a high cervical position can be excised transorally using video-laryngoscopic surgery (TOVS) without mandibular dissection. |
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