Resection of Parapharyngeal Space Tumors Located in the Prestyloid Compartment: Efficacy of the Cervical Approach

Background Parapharyngeal space tumors are rare. Among them, tumors in the prestyloid compartment are particularly suitable for surgery; however, there are no detailed reports of such surgery and their features remain unknown. Methods We conducted a retrospective cohort study. For 67 surgical cases of benign tumors in this compartment, we examined the patient and tumor characteristics, fine-needle aspiration cytology (FNAC), and intraoperative details such as surgical approach, use of complete excision, and postoperative complications. Results Pleomorphic adenomas (PAs) comprised 73.1% of the lesions. The diagnostic accuracy of FNAC to differentiate benign and malignant tumors was 97.7%. Of the treated lesions, 94.0% were removed via the cervical approach alone, including all PAs. The remaining 6.0% were resected via the cervical-parotid approach. The median operative time and bleeding volume were 89 min and 50 mL, respectively. Operative time using the cervical approach was significantly shorter (p = 0.021). All cases could be treated via complete surgical excision. Postoperative complications occurred in 32.8% of patients, with transient slight facial palsy being the most common. No fatal complications occurred and 92.5% of patients had no sequelae. There was no significant association between complications and surgical approach. Conclusion Based on diagnosis by FNAC, with a high accuracy rate, most benign prestyloid tumors, especially PAs, were resected using the cervical approach alone, with a shorter operative time and without severe complications.