title: Cervical sympathetic chain schwannoma masquerading as a carotid body tumour with a postoperative complication of first-bite syndrome.
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.
authors.affiliation: Department of ENT, Mid-Western Regional Hospital, Limerick, Ireland. paulacasserly@hotmail.com
authors.forename: Paula
authors.initials: P
authors.lastname: Casserly
authors.forename: Patrick
authors.initials: P
authors.lastname: Kiely
authors.forename: John E
authors.initials: JE
authors.lastname: Fenton
mesh_terms: D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002342:Carotid Artery, External / Q000473:pathology; D002343:Carotid Artery, Internal / Q000473:pathology; D002345:Carotid Body Tumor / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006732:Horner Syndrome / Q000209:etiology*; D006801:Humans; D007601:Jugular Veins / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009442:Neurilemmoma / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D014057:Tomography, X-Ray Computed