Anatomical and Surgical Aspects of The Parapharyngeal Space

The parapharyngeal space (PPS) is a complex potential space extending from the base of the skull to the greater coru of the hyoid bone. It is divided by the styloid process and its associated muscles into prestyloid and poststyloid compartments .The main structures contained into the prestyloid compartment include the pterygoid and tensor palati muscles, fat and the deep lobe of the parotid gland but actually the parotid gland is not included within the PPS but separated from it by the deep parotid fascia.Lesions in the PPS may be congenital or developmental like branchial cleft cyst, cystic hygroma, dermoid cyst, congenital malformation of the lymphatic channels, haemangiomas and ectopic thyroid tissue, or traumatic like organized heamatoma of the PPS, incidental emphysema during dental procedures or inflammatory like abscess and inflammatory pseudotumor. Access to tumors of the PPS is restricted since it lies deep to the parotid gland and the ramus of the mandible and it is traversed by important neurovascular structures. Thus surgical approaches include:1.Transoral approach2.Transparotid approach.3.Transcervical approach4.Transcervical - transmandibular approach.5.Extra-oral vertical ramus osteotomy approach.6.Orbito-zygomatic middle cranial fossa approach.The aim of this work is to review the anatomy of the PPS and the different lesions that are harbored in this space and the different surgical methods for accessing the PPS.