title: Neurilemmoma of the Vagus Nerve in the Poststyloid Parapharyngeal Space.
abstract: We report a large vagal neurilemmoma in the poststyloid compartment of the parapharyngeal space. A 52-year-old man was referred to our hospital with a feeling of discomfort in the left upper neck. Computed tomography showed a 30mm x 30mm x 40mm mass with inhomogeneous internal enhancement in the left carotid space. Magnetic resonance imaging revealed a 30mm × 30mm × 40mm heterogeneous mass in the area of the bifurcation of the common carotid artery. We gave a provisional diagnosis of neurilemmoma or vagal paraganglioma in the parapharyngeal space preoperatively based on the results of physical examination and imaging. We selected a transcervical-transmandibular approach. Under general anaesthesia, a tumour originating from the vagus nerve was completely extirpated while protecting the internal and external carotid arteries. Although mild postvagotomy dysphagia and hoarseness were seem for 6 months postoperatively, symptoms resolved and the patient showed a satisfactory course without recurrence after 10 years. Histological examination of the excised specimen showed antoni A and antoni B pattern. Positive immunoreactivity for S-100 protein was identified, but negative results were obtained for neuron-specific enolase, chromogranin and neurofilament. The tumour was diagnosed as neurilemmoma of the vagus nerve.
authors.affiliation: Research Associate, Department of Oral and Maxillofacial Surgery, Wakayama Medical University , Wakayama, Wakayama Prefecture, Japan .
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shinohara
authors.affiliation: Research Associate, Department of Oral and Maxillofacial Surgery, Wakayama Medical University , Wakayama, Wakayama Prefecture, Japan .
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Wakayama Medical University , Wakayama, Wakayama Prefecture, Japan .
authors.forename: Norifumi
authors.initials: N
authors.lastname: Kiga
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, Wakayama Medical University , Wakayama, Wakayama Prefecture, Japan .
authors.forename: Itaru
authors.initials: I
authors.lastname: Tojyo
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, Wakayama Medical University , Wakayama, Wakayama Prefecture, Japan .
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Fujita
keywords: Neurilemmoma; Paraganglioma; Poststyloid parapharyngeal space; Pre-mental foramen mandibulotomy