Parapharyngeal Space: Diagnostic Imaging and Intervention

Abstract

Background

Diagnosis of lesions of the parapharyngeal space (PPS) often poses a diagnostic and therapeutic challenge due to its deep location. As a result of the topographical relationship to nearby neck spaces, a very precise differential diagnosis is possible based on imaging criteria. When in doubt, imaging-guided – usually CT-guided – biopsy and even drainage remain options.

Method

Through a precise analysis of the literature including the most recent publications, this review precisely describes the basic and most recent imaging applications for various PPS pathologies and the differential diagnostic scheme for assigning the respective lesions in addition to the possibilities of using interventional radiology.

Results

The different pathologies of PPS from congenital malformations and inflammation to tumors are discussed according to frequency. Characteristic criteria and, more recently, the use of advanced imaging procedures and the introduction of artificial intelligence (AI) allow a very precise differential diagnosis and support further diagnosis and therapy. After precise access planning, almost all pathologies of the PPS can be biopsied or, if necessary, drained using CT-assisted procedures.

Conclusion

Radiological procedures play an important role in the diagnosis and treatment planning of PPS pathologies.

Key Points

• Lesions of the PPS account for about 1–2% of all pathologies of the head and neck region. The majority are benign lesions and inflammatory processes.

• If differential diagnostic questions remain unanswered, material can – if necessary – be obtained via a CT-guided biopsy. Exclusion criteria are hypervascularized processes, especially paragangliomas and angiomas.

• The use of artificial intelligence (AI) in head and neck imaging of various pathologies, such as tumor segmentation, pathological TMN classification, detection of lymph node metastases, and extranodal extension, has significantly increased in recent years.

Citation Format

• Vogl TJ, Burck I, Stöver T et al. Parapharyngeal Space: Diagnostic Imaging and Intervention. Rofo 2025; 197: 638–646

Keywords

pharynx - interventional procedures - head/neck - MR-imaging - MR-angiography

Publication History

Received: 27 February 2024

Accepted after revision: 13 September 2024

Article published online:
04 December 2024

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