Danger space red, retropharyngeal space blue and prevertebral space. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Anatomy and common pathology of the parapharyngeal space. Parapharyngeal space an overview sciencedirect topics. A rare case of large schwannoma of the parapharyngeal space. It has clinical importance in otolaryngology due to parapharyngeal space tumours and parapharyngeal abscess developing in this area. Recognize some forms of displacement of pps fat that are essential for accurate diagnosis and appropriate treatment of. Understanding the anatomy of the parapharyngeal space is important to understand the advantages, limitations, and risks of the different surgical approaches to the parapharyngeal space.
Transoral endoscopic anatomy of the parapharyngeal space. Approaches to the parapharyngeal space request pdf. A detailed understanding of the anatomy of the neck and the propagation of infection between neck spaces is imperative when formulating a safe and successful treatment plan. Deep lobe parotid tumors may extend into the parapharyngeal space and present in the mouth. Treatment of these tumors is surgical through an external neck approach. Tumors of the parapharyngeal space jama otolaryngology. Reactive changes in the parapharyngeal and masticator spaces are also noted arrowhead, suggesting that an abscess was more likely. The anatomy of the parapharyngeal segment of the internal.
Anteriorly and inferiorly this space communicates with the spaces associated with the floor of the mouth. Management of parapharyngeal and retropharyngeal space infections. The lesion caused loss of the fat plane between the parapharyngeal space and masticator space with subsequent inflammation of the pterygoid space. To describe the imaging features of a variety of disease processes that may occur in the pps. General anatomy regions of human body regions of head deep spaces of face and neck parapharyngeal space.
The parapharyngeal space also termed the lateral pharyngeal space or prestyloid parapharyngeal space, shaped like a cone or a pyramid, inverted with its base at the sphenoid bone, with its apex inferiorly pointing to the greater cornu of the hyoid bone. It occupies the space between muscles of mastication and the muscles of deglutition. The facial nerve has considerable variation in the distribution of peripheral branches. The parapharyngeal space has also been referred to in the literature as the lateral pharyngeal, peripharyngeal, pharyngomaxillary, pterygopharyngeal, pterygomandibular, and pharyngomasticatory space, and its boundaries have been described with more variation than those of any other space of the neck.
The parapharyngeal space pps is a deep space of the neck shaped as a tilted up. Only 20% of these neoplasms are malignant and 50% of these neoplasms arise from the deep lobe of the parotid gland or minor salivary glands. A rare case of primary parapharyngeal tumor with coincidentally diagnosed contralateral thyroid tumor is being reported here in an adult male who presented to ent opd with only complaint of pain during swallowing. May 11, 2020 the retropharyngeal space is a fascial space that transverses the length of the neck in its entirety. The retropharyngeal space is a fascial space that transverses the length of the neck in its entirety. The parapharyngeal space pps with its complex anatomy is a rare location for head and neck neoplasms. Encountering a parapharyngeal mass with cystic appearance on imaging, one should rule out thyroid malignancy as differential diagnosis. The parapharyngeal space is a deep potential neck space, with inverted pyramid in shape and extends from the base of the skull to the hyoid bone below. There are no restrictions, and colleagues are welcome to use, copy and quote as they wish. May 01, 2020 the parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. Parapharyngeal space article about parapharyngeal space by.
To demonstrate diagnostic approach of pps lesions by using ct and mr techniques. A thyroid tumor extending to the parapharyngeal space. The parapharyngeal space is shaped like an inverted pyramid, with its base at the skull base, with its apex. Approaches to the parapharyngeal space plastic surgery key. Anatomy of the parapharyngeal space potential space inverted pyramid with floor at skull base, tip at hyoid, and bounded by the pharyngeal wall medially and the mandible2012 laterally 4. The parapharyngeal space is a potential space occupied by adipose tissue, cranial nerves v, ix, xi, and xii, the deep cervical lymph nodes, and the ascending pharyngeal and maxillary arteries. Parapharyngeal space tumor manifesting as an oropharyngeal mass. Both benign and malignant tumors may arise from any of the structures contained within the parapharyngeal space pps. An adequate knowledge of the anatomy and a careful.
Schwannoma originating from the peripheral nerves is a rare lesion of the parapharyngeal space. To illustrate the radiological anatomy of the parapharyngeal space pps. Oct 09, 2012 anatomy of the parapharyngeal space potential space inverted pyramid with floor at skull base, tip at hyoid, and bounded by the pharyngeal wall medially and the mandible2012 laterally 4. Trismus, drooling, dysphagia, and odynophagia also are. The anatomy of the parapharyngeal space is described in detail. Bs buccal space, ica internal carotid artery, ijv internal jugular vein, ms masticator space, pms pharyngeal mucosal space, pps parapharyngeal space, ps parotid space, pvs prevertebral space, rps retropharyngeal space, sms submandibular space, t torus tubarius. The involvement of the parapharyngeal space pps and the retropharyngeal space rps poses significant diagnostic and therapeutic problems. It is continuous with the parapharyngeal space anteriorly and the sublingual space. Approaches to the diagnosis and treatment of tumors of the. Management of parapharyngealspace tumors request pdf. After locating the aforementioned anatomic areas on mr images. Axial mri sequence illustrating the deep spaces of the head and neck. Surgical and ct examinations of 104 patients, each of whom presented with a parapharyngeal space mass, has resulted in the development of an updated ct protocol designed to provide a preoperative diagnosis.
The parapharyngeal space may be divided into two compartments on the basis of its relationship to the styloid process or, more precisely, to the tensorvascularstyloid fascia fig. These lesions could be classified as being either hypervascular glomus tumors or metastatic kidney, thyroid, or venous hemangiomas or hypovascular salivary gland tumors, neurogenic tumors, lymphomas, sarcomas. Contents 1 prestyloid part of parapharyngeal space. A modified method for locating parapharyngeal space neoplasms on. Parapharyngeal space the parapharyngeal space is shaped like a pyramid, inverted with its base at the skull base, with its apex inferiorly pointing to the greater cornu of the hyoid bone.
A thyroid tumor extending to the parapharyngeal space bmc. The pps represents a triangular fatcontaining space lateral to the. Tumors of parapharyngeal space iowa head and neck protocols. Sep 05, 2019 tumors of the parapharyngeal space pps, a potential space lateral to the upper pharynx, are uncommon, comprising less than 1% of all head and neck neoplasms. Anatomical complexity and etiology med j malaysia vol 62 no 5 december 2007 415 medial displacement of the lateral pharyngeal wall and tonsil is a hallmark of a parapharyngeal space infection. Dec 01, 20 parapharyngeal space tumors account for less than 1% of all head and neck neoplasms. Common routes of infections of parapharyngeal space. The term parapharyngeal space is widely used as a synonym of the lateral pharyngeal space, but the definition of the parapharyngeal space remains unclear because. Prestyloid muscular compartment medialtonsillar fossa lateralmedial pterygoid contains fat, connective tissue, nodes poststyloid neurovascular compartment carotid sheath cranial nerves ix, x, xi, xii sympathetic chain stylopharyngeal aponeurosis. Its borders include the nasopharynx and oropharynx. The parapharyngeal space pps is a potential space between the skull base above and the hyoid bone below.
It consists largely of fat, neurovascular structures, and, in some definitions, the retromandibular part of the deep lobe of the parotid gland. Retropharyngeal space entire length of neck boundaries. Parapharyngeal space spatium parapharyngeum is space lateral and dorsolateral to pharynx, medially continues into retropharyngeal space boundaries. Anatomy and common pathology of the parapharyngeal space epos. Parapharyngeal space, infratemporal fossa, imaging. The metastasis of papillary thyroid carcinoma to the parapharyngeal space is rare and discussed in the english literature before.
Contemporary management of primary parapharyngeal space. Parapharyngeal space tumor manifesting as a neck mass. The anatomical dissection was performed in 10 cadaveric specimens and several crucial. This space connects to every other major fascial neck space and is divided into anterior and posterior compartments by the styloid process. Tumors of this space are rare, accounting for 0, 5 % of head and neck neoplasms. Parapharyngeal space is divided by styloid septum, which runs from stylohyoid lig. The parapharyngeal pharyngomaxillary space is lateral to the superior pharyngeal constrictor and medial to the pterygoid muscle. The imaging anatomy of the parapharyngeal space pps. The pharyngeal mucosa of the left lateral pharyngeal wall was effaced owing to mass effect figure, a. The parapharyngeal space is a deeply situated space on either side of head.
The parapharyngeal space is a complex anatomical area. This is part of the throat and, by extension, the digestive system. The parapharyngeal space, also known as the prestyloid parapharyngeal space, is a deep compartment of the head and neck around which most other suprahyoid fascial spaces are arranged. The parapharyngeal space also termed the lateral pharyngeal space, is a potential space in the head and the neck. The parapharyngeal space is divided into two parts by styloid process and its attachments. A stepbystep logical approach with surgical considerations. Parapharyngeal space anatomy neck human anatomy scribd. The importance of the parapharyngeal space also lies in its relationship with the other spaces of the neck. The objective of this study is to illustrate the detail anatomy of the parapharyngeal segment of the ica ppica to safe endoscopic endonasal surgery.
Salivary gland neoplasms benign to malignant ratio 3. Anterior border pharynx and esophagus buccopharyngeal fascia posterior border alar layer of deep fascia superior border skull base inferior border superior mediastinum combines with buccopharyngeal fascia at level of t1t2. Parapharyngeal space definition of parapharyngeal space by. Contents fat main component trigeminal nerve cn v internal maxillary artery ascending pharyngeal artery. Furthermore, a clinical division of the parapharyngeal space in the superiorinferior axis is established. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of.
It sits posterior to the buccopharyngeal layer of middle cervical fascia which covers the esophagus and the pharynx and is anterior to the alar fascia. It is classed as one of the suprahyoid fascial spaces because it is situated on the lateral aspect of the pharynx and is continuous with the retropharyngeal space posteriorly and the submandibular space anteriorly. When dynamic scanning is used, diagnostic angiography or digital venous imaging dvi can be avoided in almost all of these cases. The parapharyngeal space is described as a potential space located in the head and neck, particularly at the pharynx. Any information contained in this pdf file is automatically generated from digital. It is an inverse triangle where the base is formed by base of skull, while apex is formed by hyoid bone. Scottbrowns otorhinolaryngology is used the world over as the definitive reference for trainee ent surgeons, audiologists and trainee head and neck surgeons, as well as specialists who need detailed, reliable and authoritative information on all aspects of. Background the pps is defined as the deepest space in the neck and it consists of the pre. It consists largely of fat, neurovascular structures, and, in some definitions, the. Parapharyngeal abscess msd manual professional edition.
The parapharyngeal space pps is a space in the suprahyoid neck that contains fat and is surrounded by several other spaces defined by the fascial layers of the neck. Synonyms for parapharyngeal space in free thesaurus. Medical definition of parapharyngeal space merriamwebster. The parapharyngeal space is a deep potential neck space, with inverted pyramid in shape and extends. Its borders include the nasopharynx and oropharynx medially, the masticator space anterolaterally, the deep lobe of the parotid gland posterolaterally, and the retropharyngeal space posteromedially fig. The special traits of the presented case included the following. This article presents the spatial anatomy of the pps and describes the displacement patterns of the pps fat that are essential for accurate diagnosis and appropriate treatment of. Tumors of the parapharyngeal space appear as painless masses bulging into the tonsillar, nasopharyngeal, or retromandibular area. Tumors must be at least 2 cm in size before the bulge or abnormality is palpable. A combined neurosurgical approach is indicated for tumors.
A dislocated lateral pharyngeal wall with mild inflammatory changes of the oropharyngeal mucosa was observed during. Salivary gland cancer is rare but the most frequent malignant tumor in the parapharyngeal space. An appreciation of the complex anatomy of potential spaces and fascial planes of the neck is vital to understanding lesions and their potential complications. Parapharyngeal space pps tumors are rare and account for only 0. Primary parapharyngeal tumors are rare tumors and 80% of them are benign.
Parapharyngeal space radiology reference article radiopaedia. The usefulness of this classification in helping the surgeon to decide which surgical approach is the most suitable for a particular lesion is discussed. It has a constant location anterior to the attachment of the digastric muscle as it exits the stylomastoid foramen. It is also a key anatomic landmark for localizing disease processes in the surrounding spaces of the neck. Introduction less then 1% of head and neck neoplasms 7080% are benign radiological imaging very important for diagnosis surgical excision is the primary treatment morbidity of surgery should be considered along with natural history of disease in making a treatment plan. Parapharyngeal space tumors are rare and account for 0. Approach to masses in head and neck spaces springerlink. The diagnosis of tumor in this space is essentially made by understanding the anatomy of this space. Jul 04, 2016 the prestyloid space contains the deep lobe of the parotid, minor salivary gland, parapharyngeal fat pad, and few lymph nodes. Parapharyngeal space mass laryngology jama otolaryngology. In some sources the lateral pharyngeal space is divided into 2 parts by the fascial condensation called aponeurosis of zuckerkandl and testut, joining the styloid process to the.
We retrospectively studied tumors of the parapharyngeal space treated at the baylor college of medicine affiliated hospital system, houston, from 1972 to 1985. Sep 28, 2016 the parapharyngeal space pps is a potential space between the skull base above and the hyoid bone below. The parapharyngeal space surrounds the pharynx and harbors 0. A parapharyngeal tumor with coincidentally diagnosed. Infections from this space can easily spread to the carotid and retropharyngeal spaces. Pdf transoral endoscopic anatomy of the parapharyngeal. This space is most commonly involved in neck space infections. Imaging of parapharyngeal space lesions focus on the prestyloid compartment ji hoon shin 1, ho kyu lee 1, sang yoon kim 2, choong gon choi 1 and dae chul suh 1. Branchial cleft cysts are the most common neck masses in adults. Schwannoma of the parapharyngeal space request pdf. This article will highlight the main anatomical information that is known about the parapharyngeal space and.
The masticator and parotid spaces are located laterally, the pharyngeal mucosal space is. Mostly these cysts arise from second branchial cleft and occur in the neck, anterior to the sternocleidomastoid muscle at the mandibular angle. This fascial space is also known as the lateral pharyngeal space. The parapharyngeal space, is a potential space in the head and the neck. Most are benign and represent a wide range of tumor growth, from parotid extension to intrinsic growth of nerves, blood vessels, and salivary gland tissues within or around the parapharyngeal area. Deep neck space infections involving the parapharyngeal space ppsor retropharyngeal space rps are potentially lifethreatening conditions. Imaging of parapharyngeal space and infratemporal fossa. This article presents the spatial anatomy of the pps and describes the displacement patterns of the pps fat that are essential for accurate diagnosis and appropriate. Common differentials of true pps lesions and their imaging features. Clinical assessment of lesions in this space in very difficult. Often, a parapharyngeal space pps lesion is discovered incidentally on routine physical examination. Anatomy of the parapharyngeal space pps, as depicted by magnetic resonance imaging mri. Parapharyngeal definition of parapharyngeal by medical. Even malignant parapharyngeal space tumors can be asymptomatic for a longer time, and even large tumors only produce unspecific symptoms.
The poststyloid compartment contains the carotid sheath and cervical sympathetic chain. Malignant peripheral nerve sheath tumor in the parapharyngeal space. The displacement patterns of pps fat that are essential for accurate diagnosis and appropriate treatment of pathology arising in this region. The case presented here is a 22yearold woman who was referred to our clinic with complaints of painless neck mass, dysphagia and. The parapharyngeal space, an inverted pyramidshaped region, extends from the skull base to the greater cornu of the hyoid bone.
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