James Netterville
Faculty Member

Tumors of the cervical sympathetic chain--diagnosis and management.

Langerman A, Rangarajan SV, Athavale SM, Pham MQ, Sinard RJ, Netterville JL
Head Neck. 2013 35 (7): 930-3

PMID: 23002012 · DOI:10.1002/hed.23050

BACKGROUND - Tumors originating from the cervical sympathetic chain are uncommon but important entities in the differential diagnosis of parapharyngeal space masses.

METHODS - We conducted a retrospective review of patients presenting with tumors of the cervical sympathetic chain.

RESULTS - Twenty-four patients presented between 1994 and 2010. Presenting symptoms were dysphagia (n = 7.29%), neck mass (n = 7.29%), throat fullness (n = 4.17%), and Horner syndrome (n = 2.8%). Although radiologic images showed classic lateral displacement of the carotid arteries in 10 patients (42%), in 9 patients (38%) the radiologic findings demonstrated splaying of the carotid arteries similar to carotid body tumor, and in 5 patients (20%), the findings were indeterminate. Twenty-one patients underwent surgical removal of the tumors with pathology revealing 10 paragangliomas, 10 schwannomas, and 1 neurofibroma. Horner (57%) and first-bite (33%) syndromes were the most common complications.

CONCLUSIONS - Although anterolateral displacement of the carotids is suggestive of a sympathetic tumor, absence of these findings does not rule out this entity. To this end, we have included in this review a guide to preoperative radiologic diagnosis of parapharyngeal space lesions.

Copyright © 2012 Wiley Periodicals, Inc.

MeSH Terms (9)

Diagnosis, Differential Head and Neck Neoplasms Humans Neurilemmoma Neurofibroma Paraganglioma Peripheral Nervous System Neoplasms Retrospective Studies Tomography, X-Ray Computed

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