Objective:To analyze the clinical characteristics and risk factors of postoperative first bite syndrome（FBS） after parapharyngeal space surgery, and to provide evidence-based recommendations for the diagnosis and management of this complication. Methods:A retrospective analysis was conducted on 142 patients undergoing parapharyngeal space surgery from March 2016 to November 2024, including 12 cases of postoperative FBS. Univariate analysis compared differences in tumor location, pathological type, and surgical approach between FBS and non-FBS groups. Multivariate logistic regression identified independent risk factors. A systematic literature review evaluated the preventive value of transoral endoscopic surgery for FBS, followed by proposed clinical optimization strategies. Results:The incidence of FBS was 8.45%（12/142）. Univariate analysis revealed significant associations with: Superior parapharyngeal space tumors（OR=3.21, 95%CI 1.12-9.21, P=0.029）; Schwannoma pathology（OR=4.05, 95%CI 1.35-12.18, P=0.013）; Traditional lateral cervical approach（OR=5.67, 95%CI 1.89-17.02, P=0.002）. Multivariate analysis confirmed lateral cervical approach（aOR=4.98, 95%CI 1.62-15.31, P=0.005） and schwannoma（aOR=3.75, 95%CI 1.22-11.51, P=0.021） as independent risk factors. Literature review suggested lower FBS rates with transoral endoscopic approaches. The overall effect of the drug on FBS is poor. Conclusion:FBS is a frequent complication of parapharyngeal space surgery, significantly associated with tumor location, pathology, and surgical approach. Transoral endoscopic surgery can effectively reduce the risk of FBS through precise anatomical dissection that minimizes sympathetic nerve injury. Minimally invasive approaches are recommended for eligible cases.
Humans ; Retrospective Studies ; Postoperative Complications/etiology* ; Risk Factors ; Endoscopy ; Parapharyngeal Space/surgery* ; Male ; Female ; Adult ; Middle Aged ; Neurilemmoma/surgery*

Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of "neck pseudoaneurysm, neck infection, parapharyngeal abscess" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10 case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.
Aged, 80 and over ; Humans ; Male ; Abscess/diagnosis* ; Aneurysm, False/diagnosis* ; Carotid Artery, Common/surgery* ; Carotid Artery, Internal/surgery* ; Neck ; Parapharyngeal Space

Carcinoma, Papillary/surgery* ; Humans ; Parapharyngeal Space ; Perivascular Epithelioid Cell Neoplasms ; Thyroid Cancer, Papillary ; Thyroid Neoplasms/surgery*

Objective: To explore the surgical methods and effects of transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach. Methods: The clinical data of 23 patients who underwent resection of benign tumors in parapharyngeal space by endoscopic medial pterygomandibular raphe approach from January 2016 to July 2020 in the Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University were analyzed retrospectively. There were 14 males and 9 females with a median age of 43 years. The tumors were located in the anterior space of the styloid process in 13 cases and in the posterior space in 10 cases. The smallest tumor volume was 7.3 ml and the largest was 80.2 ml. The preoperative imaging features, the characteristics and risks of this approach in the operation were analyzed, and the feasible mode of operation was explored. Results: All patients completed the operation successfully. The intraoperative blood loss was 20 to 50 ml, with an average of 28.3 ml. The operation time was 40 to 110 min, with an average of 75.4 min. The incision length was 2 to 4 cm, with an average of 3.0 cm. The postoperative pain score was 2 to 4, with an average of 3.2. The postoperative hospital stay was 4 to 9 d, with an average of 6.7 d. Postoperative pathological diagnosis included pleomorphic adenoma (n=12), neurilemmoma (n=10) and basal cell adenoma (n=1). The patients were followed up for 6 to 60 months. There was no postoperative complication such as infection or serious bleeding, and there was no tumor recurrence after operation. Conclusion: Endoscopic resection of benign tumor in parapharyngeal space via medial pterygomandibular raphe approach is a safe, effective, and minimally invasive surgical method for the treatment of tumors in parapharyngeal space.
Adult ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; Parapharyngeal Space ; Pharyngeal Neoplasms/surgery* ; Pharynx ; Retrospective Studies