Skip to main content

Advertisement

SpringerLink
Log in

Paragangliomas of the Head & Neck: the KMC experience

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

To determine the clinical features, investigations, intra-operative findings, surgical approaches used and the results of the treatment for paragangliomas of the head and neck. Retrospective study of 14 cases of paragangliomas in head and neck seen over a period of 10 years including five carotid body tumors, seven glomus jugulares and two glomus tympanicums. HRCT scans and bilateral carotid angiography were done in all cases of glomus jugulare. Pre-operative embolization was done in most cases. The trans-cervical approach was used for all cases of carotid body. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare tumors. Postaural tympanotomy approach was used for both patients with glomus tympanicum. In one case of extratympanic glomus jugulare tumor with hypoglossal palsy, a neck exploration was done to isolate and excise the tumor. Five patients with carotid body tumors presented as unilateral, painless, pulsatile swelling in the upper neck. Intra-operatively, three of the tumors were classified into Shamlin’s Grade II and one each into Grade III and Grade I. A carotid blow-out occurred in one of the patients with Grade II disease, which was managed. ECA resection had to be done in one case. Seven patients were diagnosed to have glomus jugulare and two with glomus tympanicum. Six glomus jugulare tumors presented with hearing loss, ear discharge and obvious swelling. Glomus tympanicums presented with hearing loss but no bleeding from the ear. On examination, tumors presented with an aural polyp with no VII nerve deficits. Both tympanicums were classified as Fisch Type A, three of the jugulares classified as Type B, two as Type D2 and one as Type D1. Tumors were found to be supplied predominantly by the ascending pharyngeal artery. In three cases of Type B jugulare tumors, a post-aural tympanotomy was used. A Fisch Type A approach was done for three cases of Type D jugulare. The transcanal approach was used for both patients with glomus tympanicum. Paragangliomas are uncommon tumors that need accurate diagnosis and skilled operative techniques. Though the surgical approaches may appear complicated, the removal provides good cure rates with minimal morbidity and recurrence. Lateral skull base approaches should be the armamentarium of every head and neck surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Smith PG, Diemer DP, Schwaber MK, Levine RS (1999) Clinical evaluation of paragangliomas of the lateral skull base. In: Thawley SE, Panje WR, Batsakis JG, Lindberg RD (eds) Comprehensive management of head & neck tumors, vol 1, 2nd edn. Saunders, Philadelphia, PA, pp 424–441

    Google Scholar 

  2. Glenner GG, Grimley PM (1974) Tumours of the extra-adrenal paraganglion system (including chcmoreceptors). In: Atlas of tumour pathology. 2nd Series, Fascicle 9. Armed Forces Institute of Pathology, Washington DC

  3. von Haller A (1762) Nervus sympathicus manimus, vel intercostalis nervus. Ganglion cervicale superius. In: Elementa Physiologiae Corporis Humani. Lausanne: Fr. Grasset. Tom IV, Lib X/6-Nervi. Section 41, pp 254–257

  4. Valentin G (1840) Uber eine gangliose Anschwellung in der Jacobsonchen Anastomose des Menschen. Arch Anat Physiol Lpz 2:287

    Google Scholar 

  5. Shamblin WR, ReMine WH, Sheps SG, Harrison EG Jr (1971) Carotid body tumor (chemodectoma): clinicopathologic analysis of ninety cases. Am J Surg 122(6):732–739

    Article  PubMed  CAS  Google Scholar 

  6. Shabnam J, Noam H (2002) Mesenteric paraganglioma: a case report and review of the literature. Arch Pathol Lab Med 126:362–364

    Google Scholar 

  7. Heth J (2004) The basic science of glomus jugulare tumors. Neurosurg Focus 17(2):E2

    Article  PubMed  Google Scholar 

  8. Birchler MT, Landau K, Went PT, Stoeckli SJ (2002) Paraganglioma of the cervical sympathetic trunk. Ann Otol Rhinol Laryngol 111(12 Pt 1):1087–1091

    PubMed  Google Scholar 

  9. Waldron MN, Flood LM, Clifford K (2002) A primary glomus tumour of the facial nerve canal. J Laryngol Otol 116(2):156–158

    Article  PubMed  CAS  Google Scholar 

  10. Nielsen TO, Sejean G, Onerheim RM (2000) Paraganglioma of the tongue. Arch Pathol Lab Med 124:877–879

    PubMed  CAS  Google Scholar 

  11. DeLozier HL (1983) Chemodectoma of the cheek. A case report. Ann Otol Rhinol Laryngol 92(21):109–112

    PubMed  CAS  Google Scholar 

  12. Lanza A, Moscariello A, Villani R, Colella G (2005) Glomus tumor of the lower lip. A case report. Minerva Stomatol 54(11–12):687–690 English, Italian

    PubMed  CAS  Google Scholar 

  13. Rocha MP, Campagnolo AM, Macedo VS, Scarton FB, Rocha HP, Kuhl G (2005) Nasal paraganglioma: a case report. Rev Bras Otorrinolaringol (Engl Ed) 71(2):237–240

    Article  Google Scholar 

  14. Nwaorgu OG, Adoga AS, Onakoya PA, Adoga AA (2004) Hypopharyngeal paraganglioma: a case report. Afr J Med Med Sci 33(1):83–85

    PubMed  CAS  Google Scholar 

  15. Altinok T, Cakir E, Gulhan E, Tastepe I (2006) Tracheal glomus tumor. J Thorac Cardiovasc Surg 132(1):201–202

    Article  PubMed  Google Scholar 

  16. Demetrios S, George K, Kalman K, Eva H, Athanassios L (1999) Intrasellar paraganglioma presenting as nonfunctioning pituitary adenoma. Arch Pathol Lab Med 123:429–432

    Google Scholar 

  17. Pellitteria PK, Rinaldo A, Myssiorekm D, Jackson CG, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A (2004) Paragangliomas of the head and neck. Oral Oncol 40:563–575

    Article  Google Scholar 

  18. Baysal BE, Willett-Brozick JE, Lawrence EC, Drovdlic CM, Savul SA, McLeod DR, Yee HA, Brackmann DE, Slattery WH 3rd, Myers EN, Ferrell RE, Rubinstein WS (2002) Prevalence of SDHB, SDHC, and SDHD germ line mutations in clinic patients with head and neck paragangliomas. J Med Genet 39(3):178–183

    Article  PubMed  CAS  Google Scholar 

  19. Milunsky J, DeStefano AL, Huang XL, Baldwin CT, Michels VV, Jako G, Milunsky A (1997) Familial paragangliomas: linkage to chromosome 11q23 and clinical implications. Am J Med Genet 72(1):66–70

    Article  PubMed  CAS  Google Scholar 

  20. Neumann HP, Pawlu C, Peczkowska M, Bausch B, McWhinney SR, Muresan M, Buchta M, Franke G, Klisch J, Bley TA, Hoegerle S, Boedeker CC, Opocher G, Schipper J, Januszewicz A, Eng C, European-American Paraganglioma Study Group (2004) Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations. JAMA 292(8):943–951

    Article  PubMed  CAS  Google Scholar 

  21. Fisch V, Mattox D (1988) Microsurgery of the skull base. Thieme Verlag, Stuttgart, Germany, pp 149–153

    Google Scholar 

  22. Kollert M, Minovi A, Mangold R, Hendus J, Draf W, Bockmuhl U (2006) Paraganglioma of the head and neck—tumor control, functional results and quality of life. Laryngorhinootologie. Epub ahead of print

  23. Persky MS, Setton A, Niimi Y, Hartman J, Frank D, Berenstein A (2002) Combined endovascular and surgical treatment of head and neck paragangliomas-a team approach. Head Neck 24(5):423–431

    Article  PubMed  Google Scholar 

  24. Jackson CG, Harris PF, Glasscock ME 3rd, Fritsch M, Dimitrov E, Johnson GD, Poe DS (1990) Diagnosis and management of paragangliomas of the skull base. Am J Surg 159(4):389–393

    Article  PubMed  CAS  Google Scholar 

  25. Boedeker CC, Ridder GJ, Schipper J (2005) Paragangliomas of the head and neck: diagnosis and treatment. Fam Cancer 4:55–59

    Article  PubMed  CAS  Google Scholar 

  26. Grufferman S, Gillman MW, Pasternak LR, Peterson CL, Young WG Jr (1980) Familial carotid body tumors: case report and epidemiologic review. Cancer 46:2116–2122

    Article  PubMed  CAS  Google Scholar 

  27. Marsh M, Jenkins H (2005) Temporal bone neoplasms and lateral skull base surgery. In: Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR (eds) Cummings otolaryngology—head & neck surgery, vol 4, 4th edn. Elsevier Mosby, Philadelphia, PA, pp 3698–3737

    Google Scholar 

  28. Netterville JL, Jackson CG, Miller FR, Wanamaker JR, Glasscock ME (1998) Vagal paraganglioma: a review of 46 patients treated during a 20-year period. Arch Otolaryngol Head Neck Surg 124(10):1133–1140

    PubMed  CAS  Google Scholar 

  29. Jackson CG (2001) Glomus tympanicum and glomus jugulare tumors. Otolaryngol Clin North Am 34(5):941–970

    Article  PubMed  CAS  Google Scholar 

  30. Rinaldo A, Ferlito A, Myssiorek D, Devaney KO (2004) Which paragangliomas of the head and neck have a higher rate of malignancy? Oral Oncol 40:458–460

    Article  PubMed  Google Scholar 

  31. Lee JH, Barich F, Karnell LH, Robinson RA, Zhen WK, Gantz BJ, Hoffman HT, American College of Surgeons Commission on Cancer; American Cancer Society (2002) National Cancer Data Base report on malignant paragangliomas of the head and neck. Cancer 94(3):730–737

    Article  PubMed  Google Scholar 

  32. Alkadhi H, Schuknecht B, Stoeckli S, Valavanis A (2002) Evaluation of topography and vascularization of cervical paragangliomas by magnetic resonance imaging and color duplex sonography. Neuroradiology 44(1):83–90

    Article  PubMed  CAS  Google Scholar 

  33. Gotshal H, Gurevich T, Drory VE, Segev Y, Korczyn AD (2006) Isolated hypoglossal nerve palsy due to glomus jugulare tumour—a case report. In: Neuro-oncology. 16th Meeting of the European Neurological Society. Lausanne, Switzerland, pp 3–34

  34. Wu Z, Zhang JT, Jia GJ (2004) Postauricular tran-supracondylar approach removed jugular foramen and hypoglossal canal tumors. Zhonghua Wai Ke Za Zhi 42(3):173–176

    PubMed  Google Scholar 

  35. Husband AD, Spedding A, Davis AE (2000) Neck mass caused by an intraluminal jugular paraganglioma. J Laryngol Otol 114(5):389–391

    Article  PubMed  CAS  Google Scholar 

  36. van der Mey AG, Jansen JC, van Baalen JM (2001) Management of carotid body tumors. Otolaryngol Clin North Am 34(5):907–924

    Article  PubMed  Google Scholar 

  37. Dardik A, Eisele DW, Williams GM, Perler BA (2002) A contemporary assessment of carotid body tumor surgery. Vasc Endovascular Surg 36(4):277–283

    Article  PubMed  Google Scholar 

  38. 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(5):863–870

    PubMed  Google Scholar 

  39. Lustrin ES, Palestro C, Vaheesan K (2001) Radiographic evaluation and assessment of paragangliomas. Otolaryngol Clin North Am 34(5):881–906

    Article  PubMed  CAS  Google Scholar 

  40. Kerr JT, Eusterman VD, Yoest SM, Andersen CA (2005) Pitfalls in imaging: differentiating intravagal and carotid body paragangliomas. Ear Nose Throat J 84(6):348–350

    PubMed  Google Scholar 

  41. Garcia Fernandez R, Iwasaki-Otake L, Gomez-Acosta F, Pichardo-Romero P, Madero Preciado L, Canales-Anaya L (2000) Scintigraphy with erythrocytes labelled in vitro with 99mTc compared with 111In-octreotide in the detection of carotid glomus. Rev Invest Clin 52(1):25–30

    PubMed  CAS  Google Scholar 

  42. Brink I, Schaefer O, Walz M, Neumann HP (2006) Fluorine-18 DOPA PET imaging of paraganglioma syndrome. Clin Nucl Med 31(1):39–41

    Article  PubMed  Google Scholar 

  43. Kafie FE, Freischlag JA (2003) Carotid body tumors: the role of preoperative embolization. Ann Vasc Surg 17(6):697–698 author reply 698

    Article  Google Scholar 

  44. Maturo S, Brennan J (2006) Baroreflex failure: a rare complication of carotid paraganglioma surgery. Laryngoscope 116:829–830

    Article  PubMed  Google Scholar 

  45. Maxwell JG, Jones SW, Wilson E, Kotwall CA, Hall T, Hamann S, Brinker CC (2004) Carotid body tumor excisions: adverse outcomes of adding carotid endarterectomy. J Am Coll Surg 198(1):36–41

    Article  PubMed  Google Scholar 

  46. Mendenhall WM, Hinerman RW, Amdur RJ, Stringer SP, Antonelli PJ, Singleton GT, Cassisi NJ (2001) Treatment of paragangliomas with radiation therapy. Otolaryngol Clin North Am 34(5):1007–1020

    Article  PubMed  CAS  Google Scholar 

  47. Feigenberg SJ, Mendenhall WM, Hinerman RW, Amdur RJ, Friedman WA, Antonelli PJ (2002) Radiosurgery for paraganglioma of the temporal bone. Head Neck 24(4):384–389

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology—Head & Neck Surgery, Kasturba Medical College, Mangalore, Manipal University, Mangalore, 575001, South Kanara, Karnataka, India

    Sampath Chandra Prasad, Nikhil Thada & Kishore Chandra Prasad

  2. Department of Radiodiagnosis, Kasturba Medical College, Mangalore, Manipal University, Mangalore, Karnataka, India

    Pallavi

  3. Department of Otolaryngology—Head & Neck Surgery, District Government Wenlock Hospital, Mangalore, Karnataka, India

    Kishore Chandra Prasad

  4. First Floor, Nethravathi Building, Balmatta, Mangalore, 575001, South Kanara, Karnataka, India

    Sampath Chandra Prasad

Authors
  1. Sampath Chandra Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil Thada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pallavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kishore Chandra Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sampath Chandra Prasad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Prasad, S.C., Thada, N., Pallavi et al. Paragangliomas of the Head & Neck: the KMC experience. Indian J Otolaryngol Head Neck Surg 63, 62–73 (2011). https://doi.org/10.1007/s12070-010-0107-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-010-0107-4

Keywords

Search

Navigation