title: Ganglioneuromas involving the hypoglossal nerve and the vagus nerve in a child: Surgical difficulties.
abstract: Ganglioneuromas are benign tumors that arise from the Schwann cells of the autonomic nervous system. They are usually seen in the posterior mediastinum and the paraspinal retroperitoneum in relation to the sympathetic chain. In the head and neck, they are usually related to the cervical sympathetic ganglia or to the ganglion nodosum of the vagus nerve or the hypoglossal nerve. We describe what we believe is the first reported case of multiple ganglioneuromas of the parapharyngeal space in which two separate cranial nerves were involved. The patient was a 10-year-old girl who presented with a 2-year history of a painless and slowly progressive swelling on the left side of her neck and a 1-year history hoarseness. She had no history of relevant trauma or surgery. Intraoperatively, we found two tumors in the left parapharyngeal space-one that had arisen from the hypoglossal nerve and the other from the vagus nerve. Both ganglioneuromas were surgically removed, but the affected nerves had to be sacrificed. Postoperatively, the patient exhibited hypoglossal nerve and vocal fold palsy, but she was asymptomatic. In addition to the case description, we discuss the difficulties we faced during surgical excision.
authors.affiliation: Corresponding author: Dr. Abdul Wadood Mohammed, Valiyatharayil House, (PO) Edakkazhiyur, (DT) Thrissur, Kerala, India 680515. Email: wadood_abd@yahoo.co.in From the Department of Otolaryngology-Head and Neck Surgery (Dr. Bakshi) and the Department of Histopathology (Dr. Nada), Post Graduate Institute of Medical Education and Research, Chandigarh, India; the Department of ENT, King Faisal University College of Medicine, Al-Ahsa, Kingdom of Saudi Arabia (Dr. Mohammed); and the Vijaya E.N.T. Care Centre, Bangalore, India (Dr. Lele).
authors.forename: Jaimanti
authors.initials: J
authors.lastname: Bakshi
authors.forename: Abdul Wadood
authors.initials: AW
authors.lastname: Mohammed
authors.forename: Saudamini
authors.initials: S
authors.lastname: Lele
authors.forename: Ritambra
authors.initials: R
authors.lastname: Nada
mesh_terms: D002648:Child; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005729:Ganglioneuroma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D020437:Hypoglossal Nerve Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D009333:Neck; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010610:Pharyngeal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D020421:Vagus Nerve Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*