The intraoral growth patterns of parapharyngeal tumors: A proposed classification system

Ear Nose Throat J. 2023 Apr;102(4):251-258. doi: 10.1177/0145561321997557. Epub 2021 Mar 9.


Objective: Nearly half of parapharyngeal space (PPS) tumors present as an intraoral mass, which is diagnostically challenging. In this study, we studied whether preoperative growth patterns were associated with histopathological diagnosis for planning surgery.

Methods: We performed a cross-sectional study in patients with PPS tumors. A simplified classification scheme based on intraoral tumor growth patterns (patterns 1 and 2) was then proposed. In pattern 1, tumors bulge submucosally to the oropharynx from the soft palate, with the center convexity above the uvula. In pattern 2, tumors bulge submucosally to the oropharynx from the lateral oropharynx wall, with the center convexity below the uvula. The association of this classification with postoperative histopathological diagnosis and surgical-related events was studied.

Results: Twenty-two patients were enrolled in this study (12 with pattern 1, 10 with pattern 2). Of these, 91.7% (11/12) of pattern 1 tumors were salivary gland tumors (P < .001), and 90% (9/10) of pattern 2 tumors were neurogenic (P < .001). Pattern 2 tumors had fewer bleeding complications or needed external approaches when a transoral approach was chosen.

Conclusions: This new classification of PPS tumors facilitates the prediction of salivary gland and neurogenic tumors and can improve the accuracy of preoperative radiologic diagnosis. This system will be helpful for planning surgical interventions, such as implementing transoral approaches.

Keywords: neurogenic tumors; parapharyngeal space tumors; pleomorphic adenoma; salivary gland tumors; schwannoma; transoral robotic surgery.

MeSH terms

  • Cross-Sectional Studies
  • Humans
  • Parapharyngeal Space / pathology
  • Pharyngeal Neoplasms* / pathology
  • Retrospective Studies
  • Salivary Gland Neoplasms* / pathology
  • Uvula / pathology