Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Approximately one-third of RMS cases arise in the head and neck region, with parameningeal (PM) primaries accounting for half of these.

Head and neck rhabdomyosarcoma, particularly parameningeal RMS, presents a significant oncological challenge due to its proximity to critical neurovascular structures, its frequent locally advanced presentation, and its high risk of local failure. The parameningeal site is recognized as an unfavorable location in children with localized RMS, associated with a poorer prognosis (5-year overall survival [OS] ranging from 55% to 75%) compared to other head and neck RMS subtypes (5-year OS of 65% to 80% for non-PM RMS and 85% to 90% for orbital RMS), primarily due to the high incidence of local failure.

Surgery is a potential therapeutic option for the local treatment of RMS. However, PM RMS are typically considered unresectable and are managed with a combination of early radiotherapy (RT) and multidrug chemotherapy. Despite the use of large treatment fields and high-dose RT, achieving local control remains a significant challenge, with local failure being the most common pattern of recurrence.

Extensive surgery in the head and neck region was considered to be associated with considerable morbidity. However, advancements in minimally invasive, endoscopic, and reconstructive surgical techniques have significantly challenged this paradigm.

This presentation aims to explore the role of surgery in the management of both "resectable" and "unresectable" tumors in the treatment of head and neck RMS, particularly parameningeal RMS.