Parapharyngeal Space Tumors

  • Junkichi YokoyamaEmail author
  • Shinich Ohba


In parapharyngeal space dissection, significant complications such as dysphagia and carotid artery rupture have been reported. In order to safely resect tumors located in the narrow parapharyngeal space, indocyanine green (ICG) fluorescence imaging for navigation surgery is proposed recently. In the following case study, the usefulness of ICG fluorescent image-guided surgery for parapharyngeal space tumors has been demonstrated. Initially, 0.5 mg/kg of ICG was injected via the cephalic vein. Observation of the fluorescent image was conducted with HEMS (Hyper Eye Medical System) between 5 and 30 min after the initial injection. At first, the position of the tumor was marked over pharyngeal mucosa according to ICG fluorescence imaging with HEMS. The submucosal tumor obscured fascia was confirmed under HEMS imaging and then resected completely. As a result, all tumors displayed bright fluorescence emissions that contrasted clearly with the surrounding normal structures. Even with the submucosal tumor covered with and obscured by fascia, the tumor could be clearly observed under HEMS imaging. Tumors located behind the carotid artery and lower cranial nerves also displayed bright fluorescent emissions and could be clearly detected. As a result, the tumor could be completely resected safely and noninvasively to preserve pharyngeal functions. In conclusion, ICG fluorescence imaging is effective for the detection and resection of the parapharyngeal space tumors while preserving functions.


ICG (indocyanine green) fluorescence imaging Head and neck cancer Parapharyngeal space Parapharyngeal space tumors Minimum invasive surgery Organ preservation 

Supplementary material

Video 30.1

This video shows transoral resection of parapharyngeal space metastasis from hypopharyngeal cancer with guiding ICG imaging. Confirming the submucosal tumor obscured fascia clearly under ICG imaging with color imaging, we could then safely remove the tumor, preventing damage to the carotid artery and lower cranial nerves. (WMV 17204 kb)


  1. 1.
    Carrau RL, Myers E, Johnson J. Management of tumors arising in the parapharyngeal space. Laryngoscope. 1990;100:583–9.CrossRefGoogle Scholar
  2. 2.
    Desai SC, Sung CK, Genden EM. Transoral robotic surgery using an image guidance system. Laryngoscope. 2008;118:2187–9.CrossRefGoogle Scholar
  3. 3.
    Yokoyama J, Ooba S, Fujimaki M, et al. Impact of indocyanine green fluorescent image-guided surgery for parapharyngeal space tumors. J cranio-maxillofacial Surg. 2014;42:835–8.CrossRefGoogle Scholar
  4. 4.
    Fujimaki M, Yokoyama J, Ohba S, et al. Dynamic imaging in determining the optimum surgical time for NIR fluorescent image-guided surgery. Head Neck Oncol. 2012;4:50.Google Scholar
  5. 5.
    Poellinger A, Burock S, Grosenick D, et al. Breast Cancer: early- and late-fluorescence near-infrared imaging with indocyanine green-a preliminary study. Radiology. 2011;258:409–16.CrossRefGoogle Scholar
  6. 6.
    Yokoyama J, Ohba S. ICG fluorescent image-guided surgery in head and neck cancer. In: Kusano M, Kokudo N, Toi M, Kaibori M, editors. ICG fluorescence imaging and navigation surgery. Tokyo: Springer; 2016. p. 49–62.CrossRefGoogle Scholar
  7. 7.
    Ishizawa T, Fukushima N, Shibahara J, Masuda K, Tamura S, Aoki T, Hasegawa K, Beck Y, Fukayama M, Kokudo N. Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer. 2009;115:2491–504.CrossRefGoogle Scholar
  8. 8.
    Yokoyama J, Ito S, Ohba S, Fujimaki M, Ikeda K. A novel approach to translymphatic chemotherapy targeting sentinel lymph nodes of patients with oral cancer using intra-arterial chemotherapy. Head Neck Oncol. 2011;3:42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Otolaryngology, Head and Neck SurgeryKyorin UniversityMitaka, TokyoJapan
  2. 2.Department of Otolaryngology, Head and Neck SurgeryEdogawa HospitalTokyoJapan
  3. 3.Department of Otolaryngology, Head and Neck SurgeryJuntendo UniversityTokyoJapan

Personalised recommendations