Transoral robotic surgery for the parapharyngeal space: expanding the transoral corridor

To analyze the feasibility, surgical outcomes and possible risks and complications encountered during transoral robotic surgery (TORS) for approaching parapharyngeal space (PPS) tumours, a retrospective cohort study was conducted. Out of 108 TORS procedures performed, 5 PPS tumours were identified from May 2011- November 2017. This study included 2 retrostyloid (benign nerve sheath tumour) and 3 prestyloid tumours (pleomorphic adenoma), of which one patient had previously undergone a transcervical approach for deep lobe of parotid pleomorphic adenoma. Average tumour dimensions were 4.56 x 4.5 x 3.64 cm, with largest antero-posterior, medial-lateral and craniocaudal dimensions being, 5.1 cm, 7.1 cm and 6.5 cm, respectively. Adverse peri-operative events encountered were tumour fragmentation (n = 1), Secondary hemorrhage (n = 1) and Horner's syndrome (n = 1). Oral feeds could be initiated after 7.6 days. No recurrences were noted during a mean follow up of 21.6 months. Therefore, in properly selected cases, excellent results in terms of extracapsular resection and low morbidity can be obtained with TORS without resorting to mandibulotomy or transcervical incision.