Hemiatrophy of the Tongue Caused by an Extensive Vagus Nerve Schwannoma Masquerading as a Carotid Chemodectoma

Abstract

Background

Carotid chemodectomas or carotid body tumors are rare neoplasms, generally benign and frequently asymptomatic, which represent 0.6 % of all head and neck tumours. Schwannomas or neurilemmomas are benign, slow growing tumours that derive from the sheath of peripheral and cranial nerves. Of all neurilemmomas, 25–45 % originate from the head and neck region, with the vagus nerve being one the most encountered sites of occurrence.

Case Report

We describe a schwannoma originating from the vagus nerve mimicking a carotid body tumour and compromising the function of the hypoglossal nerve.

Discussion

Patients with lateral neck masses near the bifurcation of the carotid artery are often referred to the maxillofacial surgeon. The differential diagnosis of these lesions includes a variety of tumours among which carotid chemodectomas and vagus nerve schwannomas have a significant incidence. Both lesions may appear as completely asymptomatic, thus it is very difficult to identify the origin of the tumour based on physical examination. In making a differential diagnosis of the cervical tumours imaging studies play a key role.

Purpose

A diagnostic algorithm based on contemporary imaging modalities, which can be useful in order to distinguish between these two pathological entities is presented.