Tumors of the cervical sympathetic chain—Diagnosis and management

Background Tumors originating from the cervical sympathetic chain are uncommon but important entities in the differential diagnosis of parapharyngeal space masses. Methods We conducted a retrospective review of patients presenting with tumors of the cervical sympathetic chain. Results Twenty‐four patients presented between 1994 and 2010. Presenting symptoms were dysphagia ( n = 7.29%), neck mass ( n = 7.29%), throat fullness ( n = 4.17%), and Horner syndrome ( n = 2.8%). Although radiologic images showed classic lateral displacement of the carotid arteries in 10 patients (42%), in 9 patients (38%) the radiologic findings demonstrated splaying of the carotid arteries similar to carotid body tumor, and in 5 patients (20%), the findings were indeterminate. Twenty‐one patients underwent surgical removal of the tumors with pathology revealing 10 paragangliomas, 10 schwannomas, and 1 neurofibroma. Horner (57%) and first‐bite (33%) syndromes were the most common complications. Conclusions Although anterolateral displacement of the carotids is suggestive of a sympathetic tumor, absence of these findings does not rule out this entity. To this end, we have included in this review a guide to preoperative radiologic diagnosis of parapharyngeal space lesions. © 2012 Wiley Periodicals, Inc. Head Neck, 2013