Background: Parapharyngeal space tumors with complex anatomy and diverse histology and have remained a challenging phenomenon for treating physicians. Objective: Assess the factors for selection of surgical approach and association of neurological complications with tissue of origin in parapharyngeal space tumors. Type of review: Systematic review and meta-analysis of retrospective studies in accordance with PRISMA guidelines Methods: We have conducted a comprehensive web search on Pubmed, Web of Science, EMBASE, Cochrane Library, Biomedical Literature Database (CBM) and Clinicaltrials.gov. Two researches reviewed all identified articles independently with a third reviewer for adjudication. Patient demographics and other clinicopathological characteristics were explored. Main outcome measures: Primary outcomes assessed were post-operative complications i.e. neurological and salivary, surgical approaches used and the factors used for the selection of surgical approaches. Results: The systematic review has identified 631 patients of benign parapharyngeal space tumors with neurogenic and salivary tissue histology in 13 studies with a mean age of 42.9 ± 7.76 years and a median follow-up of 40.98 ± 19.1 months. Salivary gland (50.8%) and neurogenic (49.1%) tumors were the most common histological entities. Tumor size, location, histology, deep parotid lobe involvement and proximity to great vessels or skull base were the deciding factors in selecting the surgical approach. Factors considered to select surgical approach do not seem to have a correlation with the outcome in terms of neurological sequalae (p=0.106). Neurological deficit was observed in 48% of patients with neurogenic histology (148/310) while only 13% patients with salivary tumor developed neurological deficit. The pooled RR was 2.41 (95% CI 1.80 – 3.23, p=0.001). Conclusion: Neurologic complications are significantly associated with neurogenic benign tumors rather than surgical approach.

Objectives: To evaluate whether the extent of tumor resection and free flap reconstruction influences functional outcome and complications in patients with solid malignancies of the cheek. Design and Participants: We retrospectively assessed recipient site complications and functional outcomes in 47 patients with solid malignancies of the cheek who underwent either partial (n=30; 63.8%) or full-thickness (n=17; 36.2%) cheek resection with free flap reconstruction. Setting: Retrospective, multicentric analysis Results: Full thickness resections with creation of through-and-through defects were not associated with significantly higher complication rates (70.6% vs. 46.7%; p=0.138) compared to partial defects. Recipient site complications occurred in 55.3% of patients and were noticed most likely after reconstruction of suborbital defects (69.2%; p=0.268) of which occurrence of salivary fistulae was the most common (46.2%; p=0.035). Similarly, functional outcomes including oral incompetence, ectropion, and trismus were not affected by the extent of resection (p=0.766). However, oral incompetence was higher in patients with tumors originating from oral cavity (p=0.020) and after the performance of mandibulectomy (p=0.003). Conclusions: There was no difference in functional outcome or recipient site morbidity between tumor resections resulting in full-thickness and partial defects.