Neurilemmoma of the Vagus
Nerve in the Poststyloid
Parapharyngeal Space
Published: January 1, 2016 | DOI: https://doi.org/10.7860/JCDR/2016/.7141
Yuji Shinohara, Takashi Matsumoto, Norifumi Kiga, Itaru Tojyo, Shigeyuki Fujita
1. Research Associate, Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Wakayama Prefecture, Japan.
2. Research Associate, Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Wakayama Prefecture, Japan.
3. Assistant Professor, Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Wakayama Prefecture, Japan.
4. Assistant Professor, Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Wakayama Prefecture, Japan.
5. Professor, Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Wakayama Prefecture, Japan.
Correspondence
Dr. Yuji Shinohara,
811-1, Kimiidera, Wakayama-City 641-8509, Japan.
E-mai : ijuyar@yahoo.co.jp
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.
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