Tumors of the cervical sympathetic chain--diagnosis and management

Head Neck. 2013 Jul;35(7):930-3. doi: 10.1002/hed.23050. Epub 2012 Sep 24.


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.

MeSH terms

  • Diagnosis, Differential
  • Head and Neck Neoplasms / diagnostic imaging*
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / surgery
  • Humans
  • Neurilemmoma / diagnostic imaging*
  • Neurilemmoma / pathology
  • Neurilemmoma / surgery
  • Neurofibroma / diagnostic imaging*
  • Neurofibroma / pathology
  • Neurofibroma / surgery
  • Paraganglioma / diagnostic imaging*
  • Paraganglioma / pathology
  • Paraganglioma / surgery
  • Peripheral Nervous System Neoplasms / diagnostic imaging*
  • Peripheral Nervous System Neoplasms / pathology
  • Peripheral Nervous System Neoplasms / surgery
  • Retrospective Studies
  • Tomography, X-Ray Computed