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Table of Contents
CLINICAL CASE REPORT
Year : 2010  |  Volume : 12  |  Issue : 2  |  Page : 76-78

Superior laryngeal nerve schwanoma presenting as a neck mass: A case report


1 Senior Registrar, Associate Professor/Consultant/Chairperson Department of Otorhinolaryngology, King Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
2 Associate Professor/Consultant/Chairperson Department of Otorhinolaryngology, King Faisal University, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia

Date of Web Publication2-Jan-2020

Correspondence Address:
Nada Al-Bahrani
Senior Registrar P. O. Box 6198 Dammam 31442
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-8491.274637

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  Abstract 


This is a report of the first case of schwannoma originating from the external branch of superior laryngeal nerve. Solitary and extracranial schwannomas are extremely rare. To our knowledge, no case of schwannoma originating from external branch of superior laryngeal nerve has been reported.

Keywords: Laryngeal Nerve, Superior, neurilemmoma


How to cite this article:
Al-Bahrani N, Telmesani LM. Superior laryngeal nerve schwanoma presenting as a neck mass: A case report. Saudi J Otorhinolaryngol Head Neck Surg 2010;12:76-8

How to cite this URL:
Al-Bahrani N, Telmesani LM. Superior laryngeal nerve schwanoma presenting as a neck mass: A case report. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2010 [cited 2022 Nov 30];12:76-8. Available from: https://www.sjohns.org/text.asp?2010/12/2/76/274637




  Case Report Top


A 22 years old female presented with a history of a progressive right neck swelling of 6 weeks duration with no history of dysphagia, odynophagia or hoarseness. A right neck swelling (3 x 2 cm) at the level of the thyroid cartilage and anterior to the anterior border of sternocleidomastoid muscle was seen. It was firm, smooth , non tender or mobile, and not attached to overlying skin. No thrill or bruit were found. There was no other neck masses.

Fiberoptic nasopharyngolaryngoscopy was normal. All blood investigations were normal. Computerized tomography ( CT ) of the neck with contrast showed a well defined heterogenous soft tissue mass at the right parapharyngeal space extending from the level of the submandibular salivary gland to the thyroid cartilage with areas of necrosis and blunting effect on the lateral pharyngeal wall medially and compression on the submandibular salivary gland superiorly, adherent to and pushing the carotid sheath laterally [Figure 1].
Figure 1 axial CT scan with contrast of the patient showing the left parapharyngeal mass with a cystic component pushing the carotid laterally and the oropharynx medially

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MRI and MRA were done and showed the mass to be cystic centrally and not infilterating the carotid sheath [Figure 2].
Figure 2: T2 weighted MRI, sagittal cut showing the superoinferior dimensions of the mass

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Our differential diagnosis was; TB , paraganglioma or schwannoma. Total excisional biopsy of the mass was performed. Intraoperatively a well encapsulated and highly vascularized mass receiving direct blood supply from the external carotid artery was found. It was dissected off the right submandibular salivary gland and thyroid cartilage and found to be in close relation to the external laryngeal nerve.

Histopathological examination showed Antoni type A and Antoni type B tissue which was consistent with schwannoma.


  Discussion Top


Shwannomas were first described in 1910 by Verocay [1] . They are benign neoplasms of neural crest originating from cell. They arise from peripheral, spinal or cranial nerves ,(except Olfactory and optic nerves) [2] . The incidence is relatively common occurring 1 in 3000 births [3]. Most schwannomas originate from intracranial portion with or without combined extracranial extension [4]. It usually arises from the sensory divisions of the cranial nerves.4 Extracranially, about 25 % of all schwannomas are located in the head and neck, [5] several sites can be involved such as the parapharyngeal space, maxillary and submandibular space [4]. Schwannomas are the most common neurological tumors of the parapharyngeal space,[6] which was the case in our patient .

The growth of schwannomas is usually slow but if hemorrhage occurs around one in the parapharyngeal space, it can be life threatening [7] which could have happened in our case since the tumor was very vascular and receiving a direct supply from the superior thyroid artery.

Presentation is usually asymptomatic but focal neurological signs and symptoms may be associated with nerve compression [2].

In this patient the only positive finding was a neck mass, but on a retrograde post operative fibro-optic larygoscopy we found that the right vocal cord was at a lower level than the left vocal cord which goes with affection of the right external branch of superior laryngeal nerve.

Radiologically, schwannomas are hypodense compared with muscle on CT scan with some degree of enhancement after contrast[8]. Careful attention to the anatomic location and displacement of the vascular structures in the neck will usually lead the clinician to an accurate diagnosis which we missed in our patient [8]. Schwannomas are slowly growing tumors that charactarestically expand and thin the bony confines of the cavities and foramina in which they arise [9]. They do not cause the type of bony destruction seen with malignant lesions [9]. The site of origin of parapharyngeal space schwannomas include cranial nerves; IX, X, XI, XII and the sympathetic chain [8]. Thirty seven cases of glossopharyngeal nerve schwannoma [10] and 16 cases of accessory nerve schwanno-ma11 have been reported in the literature. Ke-Chang et al reported the 9th case of hypoglossal schwannoma [4]. One case of superior laryngeal nerve schwannoma presenting with sleep apnea have been reported by Peter et al.[6].

Involvement of motor nerves is rare,[4] especially those developing from external branch of the superior laryngeal nerve. To our knowledge no case have been reported.

Although schwannomas originate from the nerve tissue, a direct relation with a nerve can be only demonstrated in 50% of the cases [12].

Treatment is always surgical and usually requires only excision of the tumor with no local or locoregional prophylactic measures [13]. Schwannomas do not reoccur if excision is complete[13],[14]. Careful identification and preservation of neurovascularstructures prevents postoperative morbidity. To conclude schwannoma should be on the top list of the differential diagnosis of a symptomatic mass in the parapharyngeal space which enhances radiologically and hence it should be excised immediately and totally to avoid life threatening complications and to prevent recurrence.

This is the first reported case of schwannoma originating from the external branch of superior laryngeal nerv.



 
  References Top

1.
Verocay J.Multiple geschwulsted als systemrkrank ung am nervosen. In:Festchrift F.Chiari. Wien and leipzeg: W.Braunmiller. 1908:378-415.  Back to cited text no. 1
    
2.
Almeyda R, Kothari P, Chau H, Lumberworth V. Submandibular neurilemmoma; a diagnostic dilemma. J laryngol Otol. 2004; 118(2):156-8.  Back to cited text no. 2
    
3.
Wilson J.A., Mclaren M., Von Haake N.P. and Maran A.G.D. Nerve sheath tumors of the head and neck. Ear Nose Throat J.1988;67:103-10.  Back to cited text no. 3
    
4.
KE Chang, M.D., YI-Shing Leu, M.D. Hypoglossal Schwannoma in the Submandibular Space. J Laryngol Otol.2002;116, 63-64.  Back to cited text no. 4
    
5.
Triardis C, Tsalighopoulos MG, Kouloulas A, Vartholomeos A. Posterior pharyngeal wall schwannoma. J Laryngol Otol. 1987; ?  Back to cited text no. 5
    
6.
Peter Walshe, Davvid Smith, Darragh Coakeley et.al. Sleep Apnoea of unusual origin. J Laryngol Otol. 2002;116:138-139.  Back to cited text no. 6
    
7.
Robin PE, Olofsson J. Tumours of the larynx. In:Stell, PM.,ed. Scott Brown’s Otolaryngology, 5th edn, London: Butterworths,1987;193  Back to cited text no. 7
    
8.
Wax, Mark K, Shiley, Samuel G, et.al. Cervical Sympethetic Cain Schwannoma. Laryngoscope. 2004;114 (12):2210-2213.  Back to cited text no. 8
    
9.
SM Haupton and MJ Cinnamond, Schwannoma of the nasal cavity. Otorhinolaryngol Head Neck Surg. 2001;5(2):67-69  Back to cited text no. 9
    
10.
Gupta V, Kumar S, Singh AK, Tatke M.Glossopharyngeal schwannoma: a case report and rview of literature. Neurol India. 2002;50:190-3.  Back to cited text no. 10
    
11.
Kubota M; Ushikubo O.; Miyata a.; Yamaura a. Schwannoma fo the spinal accessory nerve. Clin Neuroscience. 1998;5:476-497.  Back to cited text no. 11
    
12.
Chapasco M, Ronchi P, Scola G. Neurilemmoma of the oral cavity. Minerva Stomatol. 1993;42(4):173-8.  Back to cited text no. 12
    
13.
Gallesio C, Berrone S. Schwannoma located in the tongue. Minerva Stomatol.1992;41(12):583-90  Back to cited text no. 13
    
14.
Dreher A, Gatmann R, Grevers G. Extracranial Schwannoma of the ENT region.HNO.1997;45(6):468-71.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]



 

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