Parapharyngeal space (PPS) tumors are uncommon and represent just 0.5% of all head and neck tumors. About 50% of PPS tumors have a salivary cause, 20% have a neurogenic root, and the last 30% display as benign and malignant lymphoreticular lesions, metastatic lesions, and carotid body tumors. Among the neurogenic tumors, schwannomas are the most common, with the majority originating from the vagus nerve in the post-styloid compartment. PPS tumors present as either cervical masses (50%) or intraoral masses (47%), and progressive increments in size may cause compressive symptoms such as dysphagia (11%) and dysphonia (9%), or regional neural invasion (18%). PPS tumors are determined via clinical evaluation, imaging, and histological analysis. Contrast-enhanced computed tomography scan is a beneficial diagnostic study to assess the measure and the degree of the tumor, the possible source of the tumor based on the relocation of the carotid sheath, and the conservation of parapharyngeal fat. This modality can illustrate the level of the tumor vascularity and is vital in choosing the surgical approach. For schwannomas, the gold standard preoperative investigation is diffusion-weighted gadolinium contrast magnetic resonance imaging in that it is extremely useful for the identification of the nerve of origin. The surgical approach hinges on the tumor size, suspicion of malignancy, the location and extent of the tumor, the relationship between the tumor and the major neurovascular structures, and proximity to the skull base.
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