Background
Parapharyngeal space (PPS) biopsy is an important investigation in the management of PPS tumours.  These tumours are relatively rare, and the surgeon is often faced with a wide range of differential diagnoses. There are several ways to access the PPS, with varying degrees of morbidity.
 
Objectives
We describe a seldom used, but simple and safe image-guided endoscopic approach to PPS biopsy enabling tissue to be obtained transnasally.
 
Methods
The procedure is done under GA using CT image guidance via the LandmarX system, with transnasal access to the PPS using a sampling needle.
 
Results
We believe this procedure is relatively simple, safe and reproducible. This is a less invasive approach to PPS biopsy that has been successfully used by the senior author for years without significant morbidity.  
 
Conclusions
Transnasal image guided endoscopic aspiration or biopsy of the PPS is a novel technique which has not been described previously.

Image guided transnasal endoscopic fine needle aspiration or biopsy of parapharyngeal space tumours