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

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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.

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References

  1. Wang CP, Hsiao JK, Ko JY (2004) Splaying of the carotid bifurcation caused by a cervical sympathetic schwannoma. Ann Otol Rhinol Laryngol 113:696–699

    PubMed  Google Scholar 

  2. Haubrich WS (1986) The first-bite syndrome. Henry Ford Hosp Med J 34:275–278

    Google Scholar 

  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 24:996–999

    Article  PubMed  Google Scholar 

  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 124:1133–1140

    PubMed  CAS  Google Scholar 

  5. Wax MK, Shiley SG, Robinson JL, Weissman JL (2004) Cervical sympathetic chain schwannoma. Laryngoscope 114:2210–2213

    Article  PubMed  Google Scholar 

  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 114:119–124

    Article  PubMed  CAS  Google Scholar 

  7. Badawi RA, Scott-Coombes D (2002) Ancient schwannoma masquerading as a thyroid mass. Eur J Surg Oncol 28:88–90

    Article  PubMed  CAS  Google Scholar 

  8. Myssiorek MD, Silver CE, Valdes ME (1988) Schwannoma of the cervical sympathetic chain. J Laryngol Otol 102:962–965

    Article  PubMed  CAS  Google Scholar 

  9. Panneton JM, Rusack BW (2000) Cervical sympathetic chain schwannomas masquerading as carotid body tumors. Ann Vasc Surg 14:519–524

    Article  PubMed  CAS  Google Scholar 

  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 66:52–55

    PubMed  CAS  Google Scholar 

  11. Rosner M, Fischer W, Mulligan L (2001) Cervical sympathetic schwannoma. Neurosurgery 49:1452–1454

    Article  PubMed  CAS  Google Scholar 

  12. Takimoto T, Katoh H, Umeda R (1989) Parapharyngeal schwannoma of the cervical sympathetic chain in a child. Int J Pediatr Otorhinolaryngol 18:53–58

    Article  PubMed  CAS  Google Scholar 

  13. Uzun L, Ugur MB, Ozdemir H (2005) Cervical sympathetic chain schwannoma mimicking a carotid body tumor: a case report. Tumori 91:84–86

    PubMed  Google Scholar 

  14. Aygenc E, Selcuk A, Ozdem C (2002) Hypervascular parapharyngeal schwannoma: an unusual case. Auris Nasus Larynx 29:215–217

    Article  PubMed  Google Scholar 

  15. Gujrathi CS, Donald PJ (2005) Current trends in the diagnosis and management of head and neck paragangliomas. Curr Opin Otolaryngol Head Neck Surg 13:339–342

    Article  PubMed  Google Scholar 

  16. Hood RJ, Reibel JF, Jensen ME, Levine PA (2000) Schwannoma of the cervical sympathetic chain: the Virginia experience. Ann Otol Rhinol Laryngol 109:48–51

    PubMed  CAS  Google Scholar 

  17. Benzoni E, Cojutti A, Intini S, Uzzau A, Bresadola F (2003) Schwannoma of the sympathetic chain presenting as a lateral cervical mass. Tumori 89:211–212

    PubMed  Google Scholar 

  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 52:240–245

    Article  PubMed  Google Scholar 

  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

    CAS  Google Scholar 

  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 81:953–957

    PubMed  CAS  Google Scholar 

  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 164:823–829

    PubMed  CAS  Google Scholar 

  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 25:863–870

    PubMed  Google Scholar 

  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 13:1608–1611

    Article  PubMed  Google Scholar 

  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 35:109–113

    Article  PubMed  Google Scholar 

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Conflict of interest statement

The authors declare they have no conflict of interest.

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Authors and Affiliations

  1. Department of ENT, Mid-Western Regional Hospital, Limerick, Ireland

    Paula Casserly & John E. Fenton

  2. Department of Radiology, Mid-Western Regional Hospital, Limerick, Ireland

    Patrick Kiely

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  1. Paula Casserly
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  2. Patrick Kiely
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  3. John E. Fenton
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Correspondence to Paula Casserly.

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Casserly, P., Kiely, P. & Fenton, J.E. Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome. Eur Arch Otorhinolaryngol 266, 1659–1662 (2009). https://doi.org/10.1007/s00405-008-0902-7

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  • DOI: https://doi.org/10.1007/s00405-008-0902-7

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