Abstract

OBJECTIVE: This study aims to present our clinical experience and surgical outcomes of removal of parapharyngeal space (PPS) tumors by the use of Killian’s nasal speculum for retraction of the surgical field and dissection of the mass.

METHODS: This retrospective study included 13 patients (6 males, 7 females; median age 28 years; range, 3 to 63 years) diagnosed and surgically treated for PPS tumors between January 2014 and October 2017. All patients underwent nasal speculum-assisted transoral or transcervical excision.

RESULTS: Nasal speculum-assisted transoral (n=4) or transcervical (n=9) excision was performed to remove parapharyngeal mass. Four patients had malignant mass [rhabdomyosarcoma (n=1), low grade myofibroblastic sarcoma (n=1), malignant schwannoma (n=1) and adenocarcinoma (n=1)] while nine patients had benign tumors: pleomorphic adenoma (n=4), schwannoma (n=3), paraganglioma (n=1) and ganglioneuroma (n=1). Postoperative complications were unilateral vocal cord paralysis (n=2) and unilateral hypoglossal paralysis (n=1). None of the patients had recurrence at a mean of three-year follow up.

CONCLUSION: Due to its complex anatomical structure and major vascular and neural contents, the surgery of PPS is still a challenge and requires the help of various equipment and technological tools. Killian’s long bladed nasal speculum may aid in performing safe operations with minimal incision. Combining the technique with endoscopes or microscopes when necessary increases surgical comfort with better vision and lesser complications.