title: Tumors of the cervical sympathetic chain--diagnosis and management.
abstract: 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.
authors.affiliation: Department Surgery, Section of Otolaryngology - Head and Neck Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Langerman
authors.forename: Sanjeet V
authors.initials: SV
authors.lastname: Rangarajan
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Athavale
authors.forename: Michelle Q
authors.initials: MQ
authors.lastname: Pham
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sinard
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
mesh_terms: D003937:Diagnosis, Differential; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D009442:Neurilemmoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009455:Neurofibroma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010235:Paraganglioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed