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European Archives of Oto-Rhino-Laryngology
Published in: European Archives of Oto-Rhino-Laryngology 10/2009

01-10-2009 | Case Report

Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome

Authors: Paula Casserly, Patrick Kiely, John E. Fenton

Published in: European Archives of Oto-Rhino-Laryngology | Issue 10/2009

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Abstract

Carotid body tumours (CBT) are the most common tumours at the carotid bifurcation. Widening of the bifurcation is usually demonstrated on conventional angiography. This sign may also be produced by a schwannoma of the cervical sympathetic plexus. A 45-year-old patient presented with a neck mass. Investigations included contrast-enhanced CT, MRI and magnetic resonance arteriography with contrast enhancement. Radiologically, the mass was considered to be a CBT due to vascular enhancement and splaying of the internal and external carotid arteries. Intraoperatively, it was determined to be a cervical sympathetic chain schwannoma (CSCS). The patient had a postoperative complication of first-bite syndrome (FBS).
Although rare, CSCS should be considered in the differential diagnosis for tumours at the carotid bifurcation. Damage to the sympathetic innervation to the parotid gland can result in severe postoperative pain characterised by FBS and should be considered in all patients undergoing surgery involving the parapharyngeal space.
Literature
1.
Wang CP, Hsiao JK, Ko JY (2004) Splaying of the carotid bifurcation caused by a cervical sympathetic schwannoma. Ann Otol Rhinol Laryngol 113:696–699PubMed
2.
Haubrich WS (1986) The first-bite syndrome. Henry Ford Hosp Med J 34:275–278
3.
Chiu AG, Cohen JL, Burningham AR, Andersen PE, Davidson BJ (2002) First bite syndrome: a complication of surgery involving the parapharyngeal space. Head Neck 24:996–999PubMedCrossRef
4.
Netterville JL, Jackson CG, Miller FR, Wanamaker JR, Glassock ME (1998) Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg 124:1133–1140PubMed
5.
Wax MK, Shiley SG, Robinson JL, Weissman JL (2004) Cervical sympathetic chain schwannoma. Laryngoscope 114:2210–2213PubMedCrossRef
6.
Colreavy MP, Lacy PD, Hughes J, Bouchier-Hayes D, Brennan P, O’ Dwyer AJ et al (2000) Head and neck schwannomas—a 10 year review. J Laryngol Otol 114:119–124PubMedCrossRef
7.
Badawi RA, Scott-Coombes D (2002) Ancient schwannoma masquerading as a thyroid mass. Eur J Surg Oncol 28:88–90PubMedCrossRef
8.
Myssiorek MD, Silver CE, Valdes ME (1988) Schwannoma of the cervical sympathetic chain. J Laryngol Otol 102:962–965PubMedCrossRef
9.
Panneton JM, Rusack BW (2000) Cervical sympathetic chain schwannomas masquerading as carotid body tumors. Ann Vasc Surg 14:519–524PubMedCrossRef
10.
Souza JW, Williams JT, Dalton ML, Solis MM (2000) Schwannoma of the cervical sympathetic chain: it’s not a carotid body tumor. Am Surg 66:52–55PubMed
11.
Rosner M, Fischer W, Mulligan L (2001) Cervical sympathetic schwannoma. Neurosurgery 49:1452–1454PubMedCrossRef
12.
Takimoto T, Katoh H, Umeda R (1989) Parapharyngeal schwannoma of the cervical sympathetic chain in a child. Int J Pediatr Otorhinolaryngol 18:53–58PubMedCrossRef
13.
Uzun L, Ugur MB, Ozdemir H (2005) Cervical sympathetic chain schwannoma mimicking a carotid body tumor: a case report. Tumori 91:84–86PubMed
14.
Aygenc E, Selcuk A, Ozdem C (2002) Hypervascular parapharyngeal schwannoma: an unusual case. Auris Nasus Larynx 29:215–217PubMedCrossRef
15.
Gujrathi CS, Donald PJ (2005) Current trends in the diagnosis and management of head and neck paragangliomas. Curr Opin Otolaryngol Head Neck Surg 13:339–342PubMedCrossRef
16.
Hood RJ, Reibel JF, Jensen ME, Levine PA (2000) Schwannoma of the cervical sympathetic chain: the Virginia experience. Ann Otol Rhinol Laryngol 109:48–51PubMed
17.
Benzoni E, Cojutti A, Intini S, Uzzau A, Bresadola F (2003) Schwannoma of the sympathetic chain presenting as a lateral cervical mass. Tumori 89:211–212PubMed
18.
van den Berg R, Schepers A, de Bruine FT, Liauw L, Mertens BJA, van der Mey AGL et al (2004) The value of MR angiography techniques in the detection of head and neck paragangliomas. Eur J Radiol 52:240–245PubMedCrossRef
19.
Som PM, Biller HF, Lawson W (1981) Tumours of the parapharyngeal space: preoperative evaluation, diagnosis and surgical approaches. Ann Otol Rhinol Laryngol 90(Suppl):3–15
20.
Zidi A, Bouaziz N, Mnif N, Kribi L, Kara M, Salah M et al (2000) Carotid body tumors: contribution of the various imaging techniques. A report of six cases. J Radiol 81:953–957PubMed
21.
Som PM, Braun IF, Shapiro MD, Reede DL, Curtin HD, Zimmerman RA (1987) Tumors of the parapharyngeal space and upper neck: MR imaging characteristics. Radiology 164:823–829PubMed
22.
van den Berg R, Verbist BM, Mertens BJ, van der Mey AG, van Buchem MA (2004) Head and neck paragangliomas: improved tumor detection using contrast-enhanced 3D time-of-flight MR angiography as compared with fat-suppressed MR imaging techniques. AJNR Am J Neuroradiol 25:863–870PubMed
23.
Arnold SM, Strecker R, Scheffler K, Spreer J, Schipper J, Neumann HP et al (2003) Dynamic contrast enhancement of paragangliomas of the head and neck: evaluation with time-resolved 2D MR projection angiography. Eur Radiol 13:1608–1611PubMedCrossRef
24.
Kawashima Y, Sumi T, Sugimoto T, Kishimoto S (2008) First-bite syndrome: a review of 29 patients with parapharyngeal space tumor. Auris Nasus Larynx 35:109–113PubMedCrossRef
Metadata
Title
Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome
Authors
Paula Casserly
Patrick Kiely
John E. Fenton
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
European Archives of Oto-Rhino-Laryngology / Issue 10/2009
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-008-0902-7

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