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Objectives Endoscopic and endoscopic-assisted approaches to the parapharyngeal space have been reported; however, their potential for vascular exposure has not been previously assessed. This study aims to compare the potential exposure and control of the parapharyngeal internal carotid artery (ppICA) via various approaches. Design and Main Outcome Measures Ten cadaveric specimens were dissected bilaterally, exposing the ppICA via endonasal, transoral, and transcervical approaches. Length of the exposed vessel and potential control were assessed (feasibility and time required to place an encircling suture). Results Endoscopic transoral and transcervical-transmandibular approaches expose a significantly longer segment of the ppICA (6.89 and 7.09 cm) than the transoral and endonasal approaches. Vascular control was achieved via endoscopic-endonasal, endoscopic- transoral, and open techniques in 121.6, 64.8, and 5.2 seconds, respectively. Conclusion Histopathology, goals of surgery, and familiarity of the surgeon with each technique may ultimately determine the choice of approach; however, this study suggests that exposure of the ppICA by endoscopic-assisted transoral approach is comparable to that of a transcervical-transmandibular approach. Vascular controlwas feasible under elective circumstances. However, the difficulty varied widely, potentially reflecting the challenges of controlling an injured ppICA. However, one must note that active bleeding obscures the surgical field in ways that may impair ppICA control. Furthermore, the results may not reflect clinical scenarios where tumor distorts the surgical field. Nonetheless, the study suggests that, in properly selected patients, the endoscopicassisted transoral approach avoids problems associated with unsightly scars, mandibular osteotomy, and facial nerve manipulation, whereas, the transcervical--transmandibular approach offers the swiftest vascular control. [ABSTRACT FROM AUTHOR]

Introduction Tumours of the parapharyngeal space are rare. Only 0.5% of head and neck tumours occur in this space. Surgical excision of parapharyngeal space lesions is challenging because of the anatomical complexity of the area. Presentation of case A 31-year-old male patient was referred by his general dental practitioner for removal of lower wisdom teeth due to multiple episodes of pericoronitis. At the initial examination, an incidental finding was made of a large fluctuant posterior oropharyngeal swelling. A fluid aspirate was taken from the lesion but this was inconclusive. The patient underwent an urgent MRI and CT neck revealing a large parapharyngeal mass. An incisional biopsy of the lesion confirmed the presence of a vagal nerve schwannoma which was subsequently removed via a transcervical approach. Discussion Due to their slow growing and painless nature, they are often not detected until they are large enough to palpate or visualise. It may cause secondary symptoms such as dysphagia, hoarseness and nasal obstruction. This case represents a typical presentation of a parapharyngeal schwannoma and reiterates the subtle and often ambiguous nature of the lesion. Conclusion Vagal schwannomas in the parapharyngeal space are rare. They usually present in the form of an isolated intraoral or neck mass. A positive diagnosis is made on imaging and confirmed by histopathological examination. Complete surgical excision is the treatment of choice and recurrence rates are low. [ABSTRACT FROM AUTHOR]

Liposarcomas are thought to be the most prevalent kind of soft tissue sarcoma in adults. A well-differentiated liposarcoma that has a higher incidence of a local recurrence following surgical excision is referred to as an atypical lipomatous tumor. The incidence are extremely rare in which <1 % of head and neck sarcoma cases. This is unusual liposarcoma localization warrants great interest in reporting such a case. In this report we present a case of a 50-year-old male complained with difficulty swallowing solid food and continuous presence of lump in the throat. Fiber Optic Laryngoscopy (FOL) showed a tumor filled the hypopharynx and CT scan suggested a benign mass that was most likely a fibrolipoma. Tumor was found infiltrating the lateral pharyngeal wall and protruding into the hypopharyngeal lumen. Because the tumor had spread to the right thyroid lobe, surgical excision via a transcervical approach was combined with a right thyroidectomy. There was a positive margin at the end of resection, thus a chemoradiation was added. Two years post-operative evaluation shows no sign of recurrence. The main treatment for hypopharyngeal liposarcoma is based on surgery, either through an endoscopic or transcervical approach which determined by the size of the tumor and surgical field. Adjuvant chemoradiation is given to help prevent the recurrence. • The case of liposarcoma in head and neck region is quite rare. • Hypopharyngeal liposarcoma can obstruct breathing airway and gullet. • The histopathology of lipoma and liposarcoma is sometimes difficult to distinguish. • Chemoradiation is considered where a positive margin is found after surgery to reduce the recurrence rate. [ABSTRACT FROM AUTHOR]

Parapharyngeal space tumours are rare. Pleomorphic adenoma is the commonest salivary gland tumour that is found in this space. This tumour may arise in the deep lobe of parotid gland and extend into the parapharyngeal space or may arise de novo from the aberrant minor salivary glands in parapharyngeal space. The latter entity is an extremely rare finding. CT scan and fine-needle aspiration cytology form the important diagnostic tools in case of these tumours. Surgery is the mainstay for the treatment of these tumours. The strategic location and also the extension of these tumours may at times demand to alter the surgical procedure for their excision. This article presents a case of a 27-year-old female, who presented with a mass in the right submandibular region that was excised successfully using transcervical approach in conjunction with transoral approach without mandibulotomy. The biopsy report suggested it to be “pleomorphic adenoma of minor salivary gland”.

We experienced a case of an elongated styloid process that was 8 cm in length. The patient was a 68-year-old Japanese man with frequent episodes of left-sided throat pain for 10 years. The elongated styloid process could be diagnosed by 3D-computed tomography (left and right length: 7.8 cm and 8.0 cm, respectively) and successfully treated with surgery, since the anatomic relationships could be fully visualized. Surgical methods for shortening an elongated styloid process involve an intraoral or external approach. The external approach to the styloid process involves a trans-cervical approach to the parapharyngeal space, which enables wider visualization in the operative field than an intraoral approach. In the present case, the styloid process reached the parapharyngal space. Therefore, we selected the external approach and shortened only the left-sided styloid process (the same side as the throat pain). The chief complaint disappeared immediately after the operation.

Eagle syndrome was first described by Eagle in 1937. It is associated with an elongated styloid process and/or calcification of the stylohyoid ligament, mainly resulting in pain in the orofacial region. The treatment of Eagle syndrome includes conservative treatment with physical therapy supported by medication, or surgical removal of the styloid process. Two different surgical approaches are described in the literature: the transoral and transcervical approaches. Both have their limitations and specific intraoperative risks. A modification of the transcervical approach that adds an extra security measure to the treatment of complex cases of Eagle syndrome is presented herein. The styloid process was removed by combining piezoelectric surgery, preoperative digital planning, and surgical navigation. No complication was noted, and the patient recovered quickly after surgery. A follow-up visit 2 months later showed no remaining symptoms of Eagle syndrome on the treated side. Therefore, digital planning and surgical navigation could add valuable safety measures to the treatment of complex cases of Eagle syndrome. [ABSTRACT FROM AUTHOR]

Objective: In some cases, the exposure and safeguarding of the internal carotid artery (ICA) are not easy by the maxillary swing approach that is used as a mainstay for the removal of nasopharyngeal tumors. To address this issue, we have developed a new combined transcervical and orbitozygomatic approach.Methods: A nasopharyngeal adenocarcinoma arose in a 52-year-old patient and occupied the right middle skull base extending to the ICA. We first identified and dissected the ICA from the posterolateral part of the tumor using a transcervical approach. Then, the tumor was approached and removed by an orbitozygomatic technique with hemifacial dismasking. The surgical defect was filled using a temporal muscle flap, which was divided into two parts according to the blood supply from either the anterior or the posterior deep temporal artery.Results: The postoperative course was uneventful and favorable cosmetic results were obtained. The patient has been free of carcinoma for more than 40 months after the surgery.Conclusion: Our new combined approach might be a good option for selected patients with nasopharyngeal tumors. [ABSTRACT FROM AUTHOR]

Foreign bodies in ear are very frequently encountered by an otorhinolaryngologist. They should be diagnosed and removed immediately. Otherwise it may cause complications like tympanic membrane perforation, chondritis, ossicular necrosis, facial palsy, inner ear injury or it may migrate to adjacent structures. It may migrate to subcutaneous tissue or middle ear. Migration of aural foreign body to parapharyngeal space is very rare and never been reported in literature. We are reporting this type of very unusual migrated foreign body which was recovered from the parapharyngeal space by a small incision endoscopic assisted approach after 8 years if insertion. [ABSTRACT FROM AUTHOR]

Bilateral pulmonary nodules represent a challenge in distinguishing between synchronous bronchogenic carcinomas and metastatic disease. In the case of potentially curable synchronous lung cancer, it is recommended to treat each lesion with curative intent if there is no evidence of mediastinal involvement or extrathoracic disease. In this situation, surgical staging of the mediastinum is recommended. This case shows the utility of a transcervical approach to perform precise mediastinal staging and lymphadenectomy, and to access the pleural cavity to resect a pulmonary nodule. Moreover, video-assisted mediastinoscopic lymphadenectomy combined with video-assisted lobectomy could be a good option for a radical lymphadenectomy. [ABSTRACT FROM AUTHOR]

The advent of endoscopic techniques has transformed the surgical therapy of Zenker's diverticula. Although the treatment paradigm has shifted to minimally invasive approaches with endoscopic stapling-assisted or laser-assisted repair, traditional transcervical procedures can still play a role in selected cases. The goal of this article is to illustrate our tailored approach to patients with Zenker's diverticula and illustrate our open surgical and endoscopic techniques. The discussion will also include the evidence-based rationale for our preoperative assessment and choice of technique. [ABSTRACT FROM AUTHOR]

Summary: Many articles and anatomy textbooks accurately describe the anatomy and anatomical variations of the marginal mandibular branch of the facial nerve (VII). This is not, however, true for the cervical branch, damage to which results in paralysis of the platysma and, because of its insertions at the lower lip and labial commissure, in disfigurement, especially when smiling. This may be mistaken for paralysis of the marginal mandibular branch of the facial nerve. Precise anatomical description of the cervical branch of the facial nerve allows certain technical safeguards to be determined which, if adhered to, should reduce the risk of injury, especially during surgical excision of the submandibular gland on a transcervical approach. [Copyright &y& Elsevier]

Abstract: Only about 0.5% of all head and neck neoplasms occur in the parapharyngeal space (PPS) and approximately 80% of these tumours are benign lesions. Various surgical approaches some of which are associated with mandibulotomy to increase exposure have been described. This article describes our 16-years' experience in treating 60 PPS benign tumours with special focus on our surgical techniques intended to ensure adequate mass exposure and structure safety. On the basis of our experience we assert that mandibulotomy is currently not advocated in the surgical management of benign PPS tumours i.e. not even in very select cases. The transparotid approach is the treatment of choice for parotid gland lesions involving PPS and in cases of multinodular or uninodular pleomorphic adenoma relapse involving the PPS. The transcervical approach is suitable for the safe removal of even large PPS masses in most cases. [Copyright &y& Elsevier]

Background: Carotid artery stenting (CAS) is generally performed via a transfemoral approach. A transbrachial approach is usually chosen as an alternative when CAS via a transfemoral approach is difficult. At our institutions, a transcervical approach is chosen when the previous two approach routes are not available. We reviewed CAS cases treated via the transcervical route in our 1,067 CAS series to investigate the safety, feasibility, and frequency of this procedure as an approach route of CAS. Methods: We performed 1,067 CAS procedures in 1,067 consecutive cases between December 2002 and June 2011. Initially, a transfemoral route was chosen, and secondarily a transbrachial route, the last choice was a transcervical route. A transbrachial approach was chosen in 96 (9.0 %) cases and a transcervical approach in ten (0.9 %). We reviewed the characteristics and outcomes of CAS performed via a transcervical approach. Results: CAS was successfully performed on all ten transcervical-approach patients. Eight procedures were performed under local anesthesia and two under general anesthesia. Perioperative morbidity and mortality were both 0 %. The modified Rankin scale (mRS) showed no deterioration at 3 months except for one case whose mRS became five because of an embolic stroke after aortic valve replacement. Conclusions: CAS via a transcervical approach was safe and feasible, and its frequency chosen as an approach route was 0.9 %. This procedure can be an alternative to transfemoral or transbrachial approaches when CAS via either of these approaches is too difficult. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate parapharyngeal space (PPS) tumors with regards to clinico-pathological features and pre-operative assessment and also to analyze the benefits of transcervical approach in the management of PPS tumors. We performed retrospective analysis of patients who had undergone transcervical resection of PPS tumors from May 2006 to May 2009 at KLES Dr. Prabhakar Kore Hospital and M. R. C, Belgaum. Patients were diagnosed on the basis of clinical examination, FNAC and magnetic resonance imaging. All patients were observed with an annual follow-up of at least 3 years by physical examination and ultrasonographic evaluation. The total number of patients were four; with three males and one female patient. Their age varied from 20 to 55 years with a mean age of 36 years. There were two cases of neurilemomas, one case of carotid body tumor and one case of pleomorphic adenoma. All four patients underwent surgical excision of tumor by transcervical approach. There were no major post-operative complications. All four patients are alive with no recurrence in the 3 year follow-up period. Transcervical approach is versatile, flexible and provides good access to the narrow PPS. This approach also provides good vascular control and reduced risk of post-op complications. We recommend transcervical approach even for large sized pre-styloid and post-styloid compartment benign tumors which are free from deep lobe of parotid. [ABSTRACT FROM AUTHOR]

Glomus tumours within the head and neck are highly vascular in nature and are surrounded by vital neurovascular structures. The aim of this study is to review the step-by-step surgical techniques for a posterior transjugular approach and transcervical approach and to clarify the advantages of these approaches in the treatment of glomus tumours within the head and neck. The advantage of these approaches is that a wide operative field from the jugular bulb to the cervical portion can be obtained. In addition, the bloodless operative field that is achieved by the preoperative embolisation appeared to contribute to reducing the risk of cranial nerve injury. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the benefits of the intraoral approach for removal of the submandibular gland (SMG) by comparing it with the usual method of the transcervical approach. Sixteen patients who required SMG resection for benign disorders were divided into two surgical groups who underwent surgery via the intraoral ( n = 8) or transcervical ( n = 8) approach. The intraoral approach (IOA) consisted of an incision on the floor of mouth from the caruncle of Wharton's duct to the retromolar trigone while the transcervical approach (TCA) consisted of an incision along the natural skin crease overlying the gland. The operation time, hospital stay, complications, and cosmetic appearance were compared between groups. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Most patients (88 %) of the IOA group experienced sensory defects of the lingual nerve, but these symptoms were temporary. No lasting complications were noted in the IOA group; however, one patient of the TCA group had permanent paralysis of the marginal mandibular branch of the facial nerve. The incision scars were invisible owing to the location on the mouth floor in the IOA group, whereas they were apparent even on the natural skin crease of the neck in the TCA group. In conclusion, the SMG can be removed safely and effectively by IOA with the avoidance of an external scar and of injury to the marginal mandibular nerve. We suggest that the IOA be substituted for the TCA as the primary procedure for removal of the SMG in suitably selected patients. [ABSTRACT FROM AUTHOR]

Neurogenic tumors located in the larynx are extremely rare. Among them, schwannoma is a benign encapsulated tumor originating from Schwann cells, which form nerve fiber sheaths in the peripheral nervous system. We herein report a case of a schwannoma arising from a rare subsite of the larynx and review the literature on laryngeal schwannoma. The case involved a woman with a 1-month history of globus pharyngeus and dysphagia without dysphonia. Rigid laryngoscopy and magnetic resonance imaging showed a large submucosal bulge toward the medial wall of the right pyriform fossa, pushing the right false and true vocal cords and aryepiglottic fold inward. A transcervical approach was used to completely excise the tumor without incisional biopsy or preliminary tracheotomy. Histology confirmed a benign schwannoma originating from the right paraglottic space, which was extremely rare. During follow-up, no evidence of recurrence or a residual mass was found. The transcervical approach is a useful and less invasive treatment for laryngeal schwannoma located in the paraglottic space.

Desmoplastic fibroblastoma (DF) is primarily a sporadic, rare, benign, soft-tissue tumor with an excellent prognosis and no reported recurrence to date. DF presents as a painless, slow-growing mass with symptoms due to its mass effect. We report a case of a middle-aged man presenting with a right supraclavicular mass and numbness of the right arm, eventually diagnosed as DF. After confirming the diagnosis with imaging and biopsy studies, the tumor was successfully excised using a transcervical approach with no complication or recurrence detected during the 2-year follow-up after surgery. A review of the relevant literature is presented regarding the presentation, diagnosis, and outcomes of published case reports of DF coinciding with those of our discussed case. This case report adds to the pool of uncommon DF cases mainly for its unique symptoms and location. It also highlights the necessity of health education related to painless masses that might be attributed as trivial in the community., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: We describe our experience with the postoperative sequelae, complications, and recurrences associated with resection of a series of parapharyngeal space (PPS) tumors via a transcervical approach without submandibular gland excision, parotidectomy, or mandibulotomy. Methods: We performed a retrospective review of 51 cases, 40 of which were pleomorphic adenomas and 11 of which were lipomas or schwannomas. Results: Of 30 fine-needle aspirations performed, 24 indicated pleomorphic adenoma before operation. Twenty-eight of the 30 fine-needle aspirations yielded diagnoses that were consistent with the final pathologic diagnoses. The average hospital stay was 1.05 days. After operation, there were 9 cases of trismus, 4 cases of "first bite" pain, and 7 cases of transient marginal nerve weakness. There were no recurrences over an average follow-up of 115 months. Conclusions: The majority of PPS tumors are benign. It is important to use an approach that allows complete tumor excision but does not impart undue postoperative morbidity. We demonstrate that the transcervical approach without submandibular gland excision, parotidectomy, or mandibulotomy is ideal for benign PPS tumors. [ABSTRACT FROM AUTHOR]

Extracapsular dissection (ECD) is thought to be effective in treating benign tumors and minimally invasive. Nonetheless, its application and feasibility in treating benign parapharyngeal space (PPS) tumor, the neoplasm located in the complex anatomical space, have never been investigated. The aim of this study is to evaluate the utility and efficacy of transcervical ECD in treating benign PPS tumors. From 1996 to 2009, 54 patients with PPS tumors were treated by the designated surgeon. Excluding nine patients who were initially regarded as the potential candidates for ECD treatment but failed to meet the inclusion criteria, 22 patients who received the procedure were retrospectively analyzed. In 22 enrolled patients, 10 had pleomorphic adenoma while 6 had neurilemmoma. There were 13 PPS tumors located in the prestyloid space and 9 in the poststyloid space. The median volume of PPS tumors was 22.6 cm, and the median distance from tumor to skull base was 2.3 cm. The median length of incision was 4.5 cm with the ECD intervention. No major intra- or post-operative complications were noted and post-operative courses were unremarkable in long-term follow-up. This study demonstrates that ECD is an effective and safe treatment for selected benign PPS tumors. It has a favorable clinical outcome and an acceptable aesthetic result, and can be performed in a minimally invasive fashion. Therefore, it is suggested that ECD be included in the treatment modalities of benign PPS tumors. [ABSTRACT FROM AUTHOR]

Parapharyngeal space (PPS) tumors are rare and benign in 80% of cases. Since surgeons first resected this anatomical region, the surgical approach to PPS bulks has been a hot topic due to their shape and the important structures involved. We present a series of patients treated with a transcervical or transcervical-transparotid approach to benign PPS tumors without mandibulotomy. Between May 2003 and March 2009, 18 patients (11 male and 7 female) with benign PPS tumors underwent a surgical resection, avoiding mandibulotomy. Average age of the patients was 49 years (range 3-76), average tumor size was 5.5 × 4 × 3 cm and histological examination of the resected tumors showed: seven pleomorphic adenomas of the deep parotid lobe, four schwannomas, two mycobacteriosis, two paragangliomas of the vagus nerve, one lipoma, one neurofibroma and one cavernous hemangioma. Seven patients underwent a transcervical approach, while 11 patients underwent a transcervical-transparotid approach. Excision of benign PPS tumors is possible without mandibulotomy even in the case of a large tumor mass, but exposure with the mandible in situ is certainly poor. Avoiding mandibulotomy reduces patient morbidity and hospital stay. In our experience, mandibulotomy can be avoided in most cases of benign PPS tumors leaving this procedure for malignant tumors or in patients with very poor exposure. [ABSTRACT FROM AUTHOR]

Objective/Hypothesis: Plunging ranulas (PRs) are infrequently encountered. The origin of PRs is mostly from the sublingual gland (SLG). Different routes to manage PRs include marsupialization, simple SLG excision, and combined SLG and submandibular gland (SMG) excision either transcervically or transorally. In this study, we demonstrated our experience managing PRs via transoral excision of the SLG with marsupialization. Study Design: Retrospective study. Methods: We retrospectively reviewed 20 patients at Chang Gung Memorial Hospital, Linkou, between January 1999 and April 2009. All patients received preoperative computed tomography or magnetic resonance imaging and were clinically diagnosed with PR. At surgery, the SLG was excised transorally with preservation of Wharton's duct and lingual nerve. The mucus contents of the PRs were drained through the posterior edge of the mylohyoid muscle. Results: Two patients were found to have final diagnosis of lymphangioma. Eighteen patients were eligible for analysis. The age distribution ranged from 6 to 48 years old. Sexual distribution was equally distributed. The successful rate was 17/18 (94.4%) with a lingual nerve paresthesia rate of 2/18 (11.1%). The paresthesia persisted for 3 and 6 months, respectively. One recurrent patient was salvaged by excision of the SMG and ranula. The other two recurrent patients received excision of the SMG and cyst and had a final diagnosis of lymphangioma. Conclusions: Transoral approach with excision of the SLG alone provides a high success rate (94.4%) with minor complications and could be the first choice in managing PRs. The results of this study confirm PRs mostly originate from the SLG. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Parapharyngeal space tumours are rare. Pleomorphic adenoma is the commonest salivary gland tumour that is found in this space. This tumour may arise in the deep lobe of parotid gland and extend into the parapharyngeal space or may arise de novo from the aberrant minor salivary glands in parapharyngeal space. The latter entity is an extremely rare finding. CT scan and fine-needle aspiration cytology form the important diagnostic tools in case of these tumours. Surgery is the mainstay for the treatment of these tumours. The strategic location and also the extension of these tumours may at times demand to alter the surgical procedure for their excision. This article presents a case of a 27-year-old female, who presented with a mass in the right submandibular region that was excised successfully using transcervical approach in conjunction with transoral approach without mandibulotomy. The biopsy report suggested it to be "pleomorphic adenoma of minor salivary gland". [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To evaluate the treatment results of pleomorphic adenoma (PA) of the parapharyngeal space at a single institution during a 30-year period. Study Design: A retrospective review. Methods: This study was performed by examining the records and reviewing the pathology of 44 patients with PA of the parapharyngeal space treated at a single medical center from January 1975 to November 2005. Results: Of the 44 patients with PA, 35 patients underwent 38 excisions. Eleven men and 27 women were treated surgically. Follow-up varied from 24 months to 180 months. There were three recurrences in two patients. Recurrence rates at 5 and 10 years were equal at 7.9%. Gender, age, tumor volume, surgical approach, pathologic surgical margin status, and prior resections were evaluated for significant prognostic factors. Advanced age proved a poor prognostic indicator ( P < .05). History of prior resection ( P < .01) was significant for recurrence. Positive surgical margins ( P = .69) proved a negative association. Conclusions: We report low recurrence rates in this patient population with two important prognostic indicators. History of prior resection is significant to predict recurrence. Interestingly, positive surgical margins are actually shown not to effect risk of recurrence. Local recurrence of the tumor is associated with further recurrence and less favorable prognosis. Laryngoscope, 2009 [ABSTRACT FROM AUTHOR]

Trigeminal schwannomas extending into the deep parapharyngeal space are relatively rare, and a surgical approach to such tumors has not been well established. We report four cases in which the tumors were completely removed by using a combination of three approaches. Four patients with trigeminal schwannomas extending into the extracranial space were surgically treated using a combination of the transcervical approach, anterolateral retromaxillar pathway via gingivobuccal sulcus, and epi and interdural middle fossa approach. The maximum diameters of the tumors ranged from 4 to 7 cm. Three tumors extended beyond the lower end of the maxillary sinus. All tumors were completely excised. The Karnofsky performance scales after surgery were more than 90% in all patients. Although the tumors extending to the deep parapharyngeal space are difficult to completely remove via a single approach, a combined approach is useful in these huge extracranial extensions. [ABSTRACT FROM AUTHOR]

Background: Because evidence-based data regarding the quality of video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis are lacking, a prospective trial comparing three different operative approaches was conducted to evaluate their efficacy.Methods: This prospective study enrolled 20 consecutive patients with nonthymomatous myasthenia gravis. A series of three approaches for bilateral video-assisted thoracoscopic extended thymectomy (VATET) using the anterior chest wall-lifting method (original), the original method with a flexed-neck position (modified), and the original method with a transcervical approach (final) were prospectively performed in each patient for quantitative and pathologic evaluation of the residual thymus after each approach.Results: Complete VATET required 242 +/- 48 min, with the transcervical procedure requiring 23 +/- 12 min. After the modified method, the residual thymus in the cervical region was 1.5 cm in size and weighed 0.8 g (0.8% of the entire thymus), as compared with a size of 2.2 cm and a weight of 1.3 g (3.2%) after the original method. Each value is the result of comparison with the final method. Histopathologic studies showed residual tissue in the germinal center as well as Hassall's corpuscles in more than 70% of cases.Conclusion: The findings show that VATET without the transcervical approach could be an immunologically incomplete treatment for myasthenia gravis. Therefore, the transcervical approach should be included in VATET procedures to ensure radicality. [ABSTRACT FROM AUTHOR]

Hypopharyngeal schwannoma is quite rare, with only nine cases presented in the literature to our knowledge. The presentation itself requires a distinction from malignant hypopharyngeal disease, which is usually the initial diagnosis. A transcervical approach and laryngomicrosurgery are two possible operating methods for the treatment of hypopharyngeal schwannoma. The selection of the surgical method depends on the size of the tumor. For this case, we preferred the transcervical approach without tracheotomy. In contrast to previous case reports, we were unable to trace the original nerve. [ABSTRACT FROM AUTHOR]

Abstract: Background: Usefulness of transcervical approach to hypoglossal schwannoma with paraspinal extension is described herein. Case Description: A 54-year-old woman presented with gradually worsening left hypoglossal nerve palsy. The findings were of a tumor lying in the left hypoglossal canal and paraspinal region and were consistent with hypoglossal schwannoma. Subtotal intracapsular removal of the tumor was performed via transcervical approach. The symptoms improved, and no additional symptoms were noted. Conclusion: The transcervical approach and intracapsular removal of the tumor under electrophysiological monitoring provided for successful minimally invasive surgery in this case of hypoglossal schwannoma. [Copyright &y& Elsevier]

Purpose: To report our initial experience using a transcervical approach for carotid angioplasty/stenting (CAS) that employs internal carotid artery (ICA) flow reversal for neuroprotection. Methods: Seventeen patients (15 men; mean age 65 years, range 49-77) with significant carotid stenosis (mean 88%, 8 symptomatic) were treated with protected transcervical CAS. Eleven patients were considered at high risk for carotid endarterectomy; 8 were also considered high risk for transfemoral access (unfavorable aortic arch anatomy or advanced aortoiliac occlusive disease). Anesthesia was based on patient and anesthesiologist preferences. The approach consisted of a 2-cm cutdown over the common carotid artery and placement of a 9-F sheath. ICA flow was reversed and shunted into the jugular vein during the carotid intervention. Results: Access and carotid stenting were successful in all cases. Thirteen procedures were performed under general and 4 under local anesthesia. Mean flow reversal time was 34+/-4 minutes (25 minutes in the last 7 cases). The patients tolerated the procedure well and had no neurological events. Four (23%) patients had significant oozing from the operative site; 2 developed small neck hematomas that were treated conservatively. All patients were discharged on the first postoperative day. There were no deaths, changes in neurological status, or restenosis over a mean follow-up of 12 months (range 1-24). Conclusions: Our initial experience demonstrates that a transcervical approach is a viable alternative for CAS. The procedure can be performed safely, with good initial clinical outcomes. The approach allows carotid flow reversal and emboli protection without introducing neuroprotection devices. The method appears best suited for patients at high risk for endarterectomy and transfemoral access. [ABSTRACT FROM AUTHOR]

Lipomas of the parapharyngeal space (PPS) are extremely rare. CT scan and MRI are indispensable tools to investigate these hard to access tumors. PPS lipomas are confined to either the prestyloid or post styloid compartments. We report an unusual parapharyngeal lipoma involving both the compartments of the PPS. [ABSTRACT FROM AUTHOR]

Carotid artery stenting (CAS) has been indicated as an alternative to carotid endarterectomy in high risk patients. Sometimes, an aortic arch can be anatomically unfavourable for CAS. Herein we report our experience in a case of CAS with transcervical approach. A 77-year-old male was referred to our hospital for severe subtotal occlusion of the left internal carotid artery. He had a past medical history of radiation to the head and neck for laryngeal cancer. Previous CT-angiography had shown a type III aortic with bovine arch. CAS via transcervical approach was performed with transitory reversal flow during the placement of RX Spider Filter 6 Fr (Medtronic, Minneapolis, MN). After release of 7 × 30 mm RX Xact carotid stent (Abbott Vascular, Chicago, IL) and ballooning with a 5.5 × 30 mm Rx Submarine balloon catheter (Medtronic Minneapolis, MN), angiography check showed a good result. The transcervical approach is an innovative technique where usually a shunt is created, either between the common carotid artery and the internal jugular vein or between the common carotid artery and the common femoral vein. This flow reversal reduces the risk of periprocedural embolic events. In our experience a short proximal clamping with transitory reversal flow, reduces the invasiveness of procedure with good outcomes. Transcervical carotid access with transitory reversal flow is a valid alternative in complicated patient with anatomy unfit for CAS. • Carotid stenting can be an alternative to endarterectomy in high risk patients. • Aortic arch can be anatomically unfavourable for Carotid artery stenting. • Transcervical approach is a technique suited to patients unfit for stenting. • Transcervical access with transitory reversal flow is useful in complicated patient. [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive esophagectomy (MIE) has been widely applied for the treatment of esophageal carcinoma. It is much less invasive, as it avoids employing a transthoracic procedure., Background: MIE via transcervical and transhiatal approaches has been adopted in our center. In this approach, with the assistance of single-port techniques or robotic-assisted surgical systems, the esophagus is mobilized under visualization, which is followed by the removal of esophageal and mediastinal lymph nodes., Methods: Increasing the surgical space by mediastinal insufflation or by elevation of the sternum with a hook may improve intraoperative identification of tissues and facilitate intraoperative mobilizations. The procedure can be performed simultaneously via both cervical and abdominal approaches without the need for intraoperative turning of the patient, which shortens the operative time. Also, there is no need for thoracotomy or single-lung ventilation, which avoids disturbance to the respiratory and circulation systems., Conclusions: Suitable instruments, especially state-of-the-art energy instruments, facilitate surgical separation and hemostasis. This surgical procedure has become increasingly sophisticated over the past decade, and its modular operation has been widely recognized. The feasible place of the neck-esophageal hiatus rendezvous is on the left main bronchus around the subcarinal region. Here we describe the technical features, key steps, and necessary precautions of this minimally invasive surgery for esophageal carcinoma., Competing Interests: Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-1205). Both authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.)

Objective: To investigate the clinical effect of lateral cervical approach in the treatment of cervical lymphatic tuberculosis complicated with parapharyngeal space abscess. Methods: A total of 10 patients with cervical lymph node tuberculosis complicated with tuberculous abscess in parapharyngeal space were treated. Surgery was performed using a transcervical approach. The operation time and blood loss were recorded. The level of ESR, C-reactive protein（CRP）, VAS score and the rating of Kubota drinking test before and 2 weeks after operation were compared. The incision healing, symptoms of tuberculosis poisoning, and the CT findings of the cervical lesions were compared before operation, 2 weeks after operation and at the last follow-up. Results: The operation time ranged from 65 to 130 min with an average of （99.00±21.45） min. The intraoperative blood loss ranged from 100 to 250 mL with an average of （155.00±43.78） mL. The average pre-and post-operative level of ESR was （67.60±21.94） mm/1h and （30.30±13.76） mm/1h, respectively（ U =5.500, P <0.01）; The average pre-and post-operative level of CRP was （69.70±31.13） mg/L and （42.40±19.70） mg/L, respectively（ U =22.500, P <0.05）; The average pre-and post-operative VAS score was （5.60±1.26） points and （2.50±1.27） points, respectively（ U =4.500, P <0.01）. As for Kubota drinking test, the rating was between 1-2 two weeks postoperatively. After relieving the compression, there was no obvious choking and coughing in drinking water. During the follow-up period （range: 6-24 months）, the surgical wound healed completely, and the symptoms of systemic tuberculosis poisoning disappeared. No obvious residual cavity or effusion was found in the parapharyngeal space by CT examination, nor was any protruding tissue in oropharynx. The edema of soft tissue surrounding the operational area disappeared, and the enlarged lymph nodes were significantly reduced. No sign of liquefaction, necrosis, suppuration or recurrence was observed. Conclusion: Surgery using transcervical approach effective in treating cervical lymph node tuberculosis with parapharyngeal space abscess., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)