The parapharyngeal space is the bilateral inverted pyramid-shaped potential space lateral to the pharynx, bounded medially by the pharyngeal constrictors and the tensor and levator veli palatini, laterally by the medial pterygoid and the parotid gland, posteriorly by the prevertebral fascia, and superiorly by the skull base. It is divided by the styloid process into an anterior (prestyloid) compartment containing fat, lymph nodes, and minor salivary gland tissue, and a posterior (retrostyloid or carotid) compartment containing the carotid sheath structures and cranial nerves IX-XII.
| Location | Side of the pharynx, an inverted pyramid from the skull base to the hyoid |
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A fat-filled central crossroads of the deep neck that links the masticator, parotid, peritonsillar, submandibular and retropharyngeal spaces, which is why infection and tumours spread through it.
Parapharyngeal space tumours present as a smooth medial displacement of the lateral oropharyngeal wall (tonsil), producing dysphagia, snoring, or a neck mass. MRI with gadolinium is the primary imaging for characterisation. The majority are benign: deep lobe parotid tumours (enter the space through the stylomandibular tunnel), schwannomas, and paragangliomas. Malignant lymphoma and direct extension from pharyngeal carcinoma are the main malignant causes. Surgical access is via a transcervical, transparotid, or combined approach.
A pleomorphic adenoma of the deep parotid lobe expanding medially through the stylomandibular tunnel into the prestyloid parapharyngeal space produces a medially displaced oropharyngeal wall and may appear as a visible swelling adjacent to the tonsil; removed by a combined transcervical-transparotid approach preserving the facial nerve throughout.
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