It is known that there are three fascia layers in the retropharyngeal area, the oropharyngeal layer, buccopharyngeal fascia, and the prevertebral fascia. The retropharyngeal space lies between the buccopharyngeal fascia and the prevertebral fascia, and extends from the skull base to the mediastinum. The prevertebral space is located between the prevertebral fascia and the vertebra, and extends from the skull base to the third thoracic vertebra. Patients with liposarcoma are usually asymptomatic unless the tumor grows to an enormous size causing cosmetic deformity or pressure effects. Furthermore, the symptoms vary depending on the anatomical location and size of the tumor. Liposarcomas in the retropharyngeal space can produce pressure symptoms such as dysphagia, dyspnea and dysphonia. Due to the adjacent of retropharyngeal space and prevertebral space, similar symptoms can be there even in prevertebral tumors. It may difficult to distinguish the retropharyngeal tumors and prevertebral tumors using imaging. But we find the retropharyngeal tumors is often confined to left or right side. Because the retropharyngeal space is divided into left and right sides by the pharyngeal raphe at the midline, and they are not connected to each other. But if the retropharyngeal tumor is enormous, it may not be confined to one side. And in this situation, liposarcoma of the prevertebral space sometimes may be misdiagnosed as retropharyngeal liposarcoma. The preliminary diagnosis of liposarcoma can be made by either CT or MRI, but histological examination is still needed to confirm the diagnosis. Due to the small number of cases of liposarcoma of the head and neck, the management of these tumors has been largely based on experience with limb and trunk tumors. The mainstay of treatment for liposarcoma is surgical excision with adequate margins. However, considering the abundance of complex and vital neurovascular and functional upper-aero digestive structures, it is difficult to achieve adequate margins in the head and neck region. Furthermore, for liposarcoma in lymph nodes with a relatively low metastasis rate, routine neck dissection is not recommended. We believe transoral surgical excision under the help of nasal endoscope may be more beneficial than the cervical approach. The indication for adjuvant radiation therapy is still unclear, some authors believe that wide surgical excision alone is sufficient for successful treatment. However, others[4–6] recommended that adjuvant radiotherapy is necessary, because they think liposarcoma often infiltrates into the surrounding structures microscopically even if it has a clear fibrous capsule. But in this case, the patient refuse to perform adjuvant radiotherapy. 8 months follow-up after the initial surgical procedure, he has done well without any evidence of recurrence. Hence, we believe complete excision via transoral approach maybe enough for liposarcoma in the prevertebral space, because the existence of fibrous capsule.
Liposarcoma of the prevertebral space sometimes may be misdiagnosed as retropharyngeal liposarcoma, but it does not change the surgical approach. Complete excision via transoral approach maybe enough.