Transoral robotic approach to the parapharyngeal space

Published Oct 4, 2026

Updated Oct 5, 2026

3D medical imaging showing a skull with highlighted structures in green and purple, showcasing anatomical details of the nasal and cranial areas.

The parapharyngeal space (PPS) is a deep and anatomically complex region of the head and neck, traditionally approached through external routes such as mandibulotomy, transparotid or transcervical approaches. Transoral robotic surgery (TORS) has introduced a less invasive route to selected lesions, avoiding external incisions and, in appropriately selected cases, providing direct access to the medial aspect of the space.

TORS provides a minimally invasive route to selected lesions of the PPS, particularly those located medially and accessible through the oropharynx. It can avoid external incisions and, in appropriately selected cases, provide direct access to the tumour while preserving surrounding structures.

Transoral anatomy of the parapharyngeal space. SP Stylopharyngeous muscle. ICA Internal carotid artery. ECA external carotid artery. SMG Submandibular gland. DG Digastric muscle. PP Palatopharyngeous muscle. SG Styloglossus muscle. SH Stylohyoid muscle. Virós. Head Neck 2024
doi: 10.1002/hed.27902.

Patient selection is critical. The relationship of the lesion to the internal carotid artery, parotid gland, medial pterygoid muscle, skull base and cranial nerves must be carefully assessed. Lesion size, location and lateral extension may determine whether a transoral, external or combined approach is most appropriate

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Transoral Robotic Approach to the Parapharyngeal Space April 26, 2021

References

Granell J, Alonso A, Garrido L, Gutierrez-Fonseca R. Transoral Fully Robotic Dissection of a Parapharyngeal Hemangioma. J Craniofac Surg. 2016 Oct;27(7):1806-1807. doi: 10.1097/SCS.0000000000003003. PMID: 27557469

Virós Porcuna D, Pollán Guisasola CM, Viña Soria C, Vergés Fort P, Palau Viarnès M, Juesas Iglesias L, De Virgilio A. Transoral robotic parapharyngeal space dissection. Head Neck. 2024 Oct;46(10):2657-2660. doi: 10.1002/hed.27902.

Vergés Fort P, Fuentes Cabrera JF, Naches Solsona S, Grau deDiego L, Escot Garcia L, Tortajada Bustelo JC, Rodríguez Sánchez JM and Virós Porcuna D (2026) Patient-specific three-dimensional planning for surgical approach selection in parapharyngeal space lesions: development of the Vall d’Hebron 3D-PPS Algorithm. Front. Oncol. 16:1954820. doi: 10.3389/fonc.2026.1954820

Books

A hand holding a surgical instrument with a black handle, overlaid with the title 'An Introduction to Robotics in Head and Neck Surgery' and 'Dissection Manual'.
Cover page for a medical publication titled 'Parapharyngeal space surgical anatomy' featuring a geometric illustration and subtitle 'From lateral approaches to Transoral Robotic Surgery'.