innovative approach with surgery video presentation

1. MANAGEMENT OF BENIGNMANAGEMENT OF BENIGN
PARAPHARYNGEAL LESIONSPARAPHARYNGEAL LESIONS
- A NEW APPROACH !- A NEW APPROACH !
Author:Author: Prof . G . Sundhar Krishnan MS,
DLO, Ph.D
Medical Director
Krishna Eye & E.N.T Hospitals
Chennai

2. Most parapharyngeal lesions areMost parapharyngeal lesions are benignbenign
Schwannoma is the commonest in theSchwannoma is the commonest in the
parapharyngeal spaceparapharyngeal space
TYPESTYPES

3. APPROACHESAPPROACHES
IntraoralIntraoral
ExternalExternal

4. DISADVANTAGES OF INTRA ORALDISADVANTAGES OF INTRA ORAL
APPROACHAPPROACH
In poststyloid lesions , neurovascularIn poststyloid lesions , neurovascular
control is difficult.control is difficult.

5. ADVANTAGES OF INTRAORALADVANTAGES OF INTRAORAL
APPROACHAPPROACH
Cosmetically acceptableCosmetically acceptable

6. DISADVANTAGES AND ADVANTAGESDISADVANTAGES AND ADVANTAGES
EXTERNAL APPROACHEXTERNAL APPROACH
Disadvantages:Disadvantages:
 Damage to neural structuresDamage to neural structures
 Osteotomies may be requiredOsteotomies may be required
 ScarScar
Advantages:Advantages:
Good exposure of pre and post styloid lesionsGood exposure of pre and post styloid lesions
Good vascular controlGood vascular control
Wider fieldWider field

7. ENDOSCOPICTRANSORAL APPROACHENDOSCOPICTRANSORAL APPROACH
AdvantagesAdvantages
Operating viewing the TV, affords good magnificationOperating viewing the TV, affords good magnification
and illuminationand illumination
Angled endoscopes afford early identification andAngled endoscopes afford early identification and
avoiding of neurovascular structuresavoiding of neurovascular structures
Superior and inferior limits of tumor can be accessed.Superior and inferior limits of tumor can be accessed.
Post operative clearance assured.Post operative clearance assured.
Less bleeding, less operating time.Less bleeding, less operating time.
Minimally invasive, less morbidity and less mortalityMinimally invasive, less morbidity and less mortality
Cosmetically acceptableCosmetically acceptable

8. DISADVANTAGE OF ENDOSCOPICDISADVANTAGE OF ENDOSCOPIC
APPROACHAPPROACH
One hand is occupied. Can be compensatedOne hand is occupied. Can be compensated
by asking the assistant to hold the endoscope.by asking the assistant to hold the endoscope.

9. CRITERIAS IN CASECRITERIAS IN CASE
SELECTIONSELECTION
FNAC proven benign lesions preferablyFNAC proven benign lesions preferably
Tumour limited to PP spaceTumour limited to PP space
Good expertise with ability to doGood expertise with ability to do
external approach in case of anyexternal approach in case of any
misadventuremisadventure

10. IMPORTANTTIPS IN OPERATINGIMPORTANTTIPS IN OPERATING
TECHNIQUETECHNIQUE
A good infiltration helps to demarcate the tumor andA good infiltration helps to demarcate the tumor and
get a good plane of dissectionget a good plane of dissection
Intracapsular dissectionIntracapsular dissection
Use angled endoscopes to view the hidden areasUse angled endoscopes to view the hidden areas
Blunt dissection done mostlyBlunt dissection done mostly
Cautery helps to decrease bleedingCautery helps to decrease bleeding

11. LEFT PARAPHARYNGEALTUMOURLEFT PARAPHARYNGEALTUMOUR

12. BRANCHIAL CYSTBRANCHIAL CYST

13. Our ExperienceOur Experience
Benign schwannoma – 3Benign schwannoma – 3
[Oropharyngeal postr. third of tongue – 1[Oropharyngeal postr. third of tongue – 1
SchwannomaSchwannoma
Hypopharyngeal (aryepiglottic fold)Hypopharyngeal (aryepiglottic fold)
Schwannoma]Schwannoma]
 Malignant Schwannoma – 1Malignant Schwannoma – 1
 Pleomorphic adenoma -3Pleomorphic adenoma -3
 Branchial cyst – 1Branchial cyst – 1
 Mucoepidermoid Carcinoma - 1Mucoepidermoid Carcinoma - 1

14. To CONCLUDETo CONCLUDE
Intraoral approach was abandoned due to its lack ofIntraoral approach was abandoned due to its lack of
versatility and increased mortality due to bleeding .versatility and increased mortality due to bleeding .
Now with the use ofNow with the use of nasal endoscopenasal endoscope thethe
drawbacks are overcome and there is resurgence ofdrawbacks are overcome and there is resurgence of
this approach.this approach.
This is an innovative technique.This is an innovative technique.