OBJECTIVES:Parapharyngeal space tumors are rare and usually benign. Their treatment is surgical and many approaches have been described. We report our experience in managing these neoplasms. Two points are developed more fully: the correlation between imaging and surgical observation and the reliability of the cervical approach.MATERIAL AND METHODS:A retrospective review of primary parapharyngeal space tumors treated at the Rennes University Hospital between 1992 and 2004 is presented. Nine patients were included, all treated surgically with a cervical approach without parotidectomy.RESULTS:Eight MR imaging and seven CT scans were done. Two retrostyloid tumors and six prestyloid tumors, all independent of the deep lobe of the parotid gland, were found. They were benign in all cases (five salivary tumors and four schwannomas). Two patients treated for a pleomorphic adenoma presented recurrence and were reoperated successfully. The average follow-up was 66 months. None of the patients died. Definitive postoperative complications occurred only for neurogenic tumors.CONCLUSION:The cervical approach is safe and allows the surgical excision of retrostyloid and prestyloid tumors, independent of the deep lobe of the parotid gland. Large tumor (8cm in our study) excision can be done with few complications. An attentive study of preoperative imaging is necessary to choose the best surgical approach.

Les tumeurs parapharyngées sont des tumeurs rares, et le plus souvent bénignes, dont le traitement est surtout chirurgical, mais avec des voies d'abord discutées. Nous décrivons notre expérience au niveau de la prise en charge diagnostique et thérapeutique de ce type de tumeurs. Les corrélations entre l'analyse de l'imagerie et les constatations chirurgicales sont plus particulièrement étudiées ainsi que la fiabilité de la voie cervicale pour le traitement. Une étude rétrospective des patients opérés d'une tumeur parapharyngée primitive au CHU de Rennes entre 1992 et 2004 est présentée. Neuf patients ont été inclus, tous opérés par voie cervicale. Huit IRM et sept TDM ont été réalisées retrouvant deux tumeurs rétrostyliennes et six tumeurs préstyliennes dont aucune ne provenait du lobe profond de la parotide. Toutes les tumeurs étaient bénignes (cinq tumeurs salivaires et quatre schwannomes). Deux patients, présentant un adénome pléomorphe, ont récidivé et ont été réopérés avec succès. Le recul moyen est de 66 mois. Il n'y a eu aucun décès. Les complications postopératoires définitives ont concerné uniquement les tumeurs nerveuses. La voie cervicale permet un traitement sûr des tumeurs parapharyngées rétrostyliennes et préstyliennes indépendantes de la parotide. L'exérèse de tumeurs bénignes volumineuses (8 cm dans notre série) est possible avec peu de complications. Une analyse fine de l'imagerie préopératoire est indispensable à une bonne prise en charge chirurgicale. Parapharyngeal space tumors are rare and usually benign. Their treatment is surgical and many approaches have been described. We report our experience in managing these neoplasms. Two points are developed more fully: the correlation between imaging and surgical observation and the reliability of the cervical approach. A retrospective review of primary parapharyngeal space tumors treated at the Rennes University Hospital between 1992 and 2004 is presented. Nine patients were included, all treated surgically with a cervical approach without parotidectomy. Eight MR imaging and seven CT scans were done. Two retrostyloid tumors and six prestyloid tumors, all independent of the deep lobe of the parotid gland, were found. They were benign in all cases (five salivary tumors and four schwannomas). Two patients treated for a pleomorphic adenoma presented recurrence and were reoperated successfully. The average follow-up was 66 months. None of the patients died. Definitive postoperative complications occurred only for neurogenic tumors. The cervical approach is safe and allows the surgical excision of retrostyloid and prestyloid tumors, independent of the deep lobe of the parotid gland. Large tumor (8 cm in our study) excision can be done with few complications. An attentive study of preoperative imaging is necessary to choose the best surgical approach.

OBJECTIVES:The management of N0 neck remains controversial. The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in managing N0 neck of oral cavity carcinomas.MATERIAL AND METHODS:A retrospective chart review of 77 previously untreated patients with squamous cell carcinomas of the oral cavity with N0 neck from 1988 to 2001 was performed. Cervical treatments were "wait and see" policy in 7 cases, neck dissection in 56 cases, radiotherapy alone in 14 cases. 77 neck dissections were performed in which 62 were selective and 15 were radical modified.RESULTS:On pathologic examination, the average number of lymph nodes was 10.7 per neck. Occult disease (cN0pN+) was detected in 32.5%, and occult extracapsular spread (cN0pN+R+) was detected in 7.8%. The median follow-up was 43 months. The overall neck recurrence rate in patients with controlled primary disease was 2.4%. Recurrent disease developed in 2.9% of the cNOpN0 neck. Regional control rate of the dissected neck was 94%. No cervical recurrence occurred in 11 patients treated with SND alone. There was no survival or recurrence rate difference in T1T2pN0 patients with or without post-operative radiotherapy. Post-operative radiotherapy could be avoided in 27% of the dissected neck. One, 3 and 5 years overall survival rate were 89.3%, 77.7% and 63.2%.CONCLUSIONS:SND is an effective procedure for staging and treating the clinically negative neck of oral cavity cancer.

La prise en charge des patients porteurs de carcinomes classés N0 reste controversée. Le but de cette étude a été d’évaluer l’efficacité de l’évidement sélectif dans le traitement des patients porteurs de carcinomes de la cavité orale classés N0. Une analyse rétrospective de 77 patients ayant présenté un carcinome épidermoïde de la cavité orale entre 1988 et 2001 a été réalisée. Le traitement ganglionnaire a été une surveillance dans 7 cas, un évidement cervical dans 56 cas, une radiothérapie seule dans 14 cas. 77 évidements cervicaux dont 62 sélectifs et 15 radicaux modifiés ont été réalisés. Le nombre moyen de ganglions examinés par évidement a été de 10,7. Le taux de métastases occultes (cN0pN+) a été de 32,5 %. Une rupture capsulaire a été détectée dans 7,8 % des cas. Le suivi moyen a été de 43 mois. Le taux global de contrôle ganglionnaire parmi les patients sans récidive locale a été de 2,4 %. Une récidive ganglionnaire est survenue dans 2,9 % des cous cN0pN0. L’efficacité globale de l’évidement cervical a été de 94 %. Aucun des 11 patients traités par évidement sélectif sans radiothérapie postopératoire n’a récidivé. Parmi les T1T2pN0 il n’y a pas eu de différence en termes de survie ou de récidive, qu’il y ait eu de la radiothérapie postopératoire ou pas. La radiothérapie a pu être évitée chez 27 % des patients traités par évidement cervical. La survie globale à 1, 3 et 5 ans a été de 89,3 %, 77,7 % et 63.2 %. L’évidement sélectif est un moyen efficace de diagnostic de l’envahissement et de traitement ganglionnaire des tumeurs de la cavité orale classées N0. The management of N0 neck remains controversial. The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in managing N0 neck of oral cavity carcinomas. A retrospective chart review of 77 previously untreated patients with squamous cell carcinomas of the oral cavity with N0 neck from 1988 to 2001 was performed. Cervical treatments were “wait and see” policy in 7 cases, neck dissection in 56 cases, radiotherapy alone in 14 cases. 77 neck dissections were performed in which 62 were selective and 15 were radical modified. On pathologic examination, the average number of lymph nodes was 10.7 per neck. Occult disease (cN0pN+) was detected in 32.5%, and occult extracapsular spread (cN0pN+R+) was detected in 7.8%. The median follow-up was 43 months. The overall neck recurrence rate in patients with controlled primary disease was 2.4%. Recurrent disease developed in 2.9% of the cNOpN0 neck. Regional control rate of the dissected neck was 94%. No cervical recurrence occurred in 11 patients treated with SND alone. There was no survival or recurrence rate difference in T1T2pN0 patients with or without post-operative radiotherapy. Post-operative radiotherapy could be avoided in 27% of the dissected neck. One, 3 and 5 years overall survival rate were 89.3%, 77.7% and 63.2%. SND is an effective procedure for staging and treating the clinically negative neck of oral cavity cancer.