Medial limit of Vagal Schwannoma; Parapharyngeal space: a case report

Abstract

Introduction- Parapharyngeal space (PPS) tumour accounts for 0.5% of all head and neck tumours. PPS tumours have various origins- salivary gland tumours, schwannomas, neurofibromas and paragangliomas. They are usually asymptomatic. 50% of PPS schwannomas are originated from vagus nerve followed by sympathetic trunk.

Case report- A 64-year-old male presented to us with hoarseness of voice for last 3 months. Tongue was deviated to left on protrusion. Bilateral tonsillar enlargement was there, left more than right with absent gag reflex. Contrast enhanced computed tomography (CECT) of neck showed tumor in left carotid sheath. Magnetic resonance imaging suggested vagal schwannoma. Patient was planned for excision of left vagal nerve schwannoma by mandibular swing approach.

Discussion – Vagal schwannoma excision has risk of nerve paresis postoperatively.

Conclusion- PPS tumors are rare, and they present with atypical clinical manifestations. The optimal procedure choice should be individualized based on availability, patient characteristics, and the surgeon’s experience.