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Introduction and Importance Schwannomas are benign tumors commonly found in the cranial vault at the cerebellopontine angle. Schwannomas could arise from any nerve that has Schwann sheath. Their most common extra-cranial localization is the parapharyngeal space. Schwannomas do not usually metastasize, and recurrence is uncommon. Case presentation We present a case of a sympathetic trunk schwannoma in a patient that presented with dysphagia and a painful neck mass. Oro-pharyngeal examination revealed the presence of a mass filling-up the left tonsillar fossa, and pushing the uvula to the right side. The larynx was also deviated to the right due to the mass effect. The mass was resected en-bloc with the involved part of the sympathetic trunk. The patient developed Horner's syndrome postoperatively. Clinical discussion The occurrence of Sympathetic trunk Schwannomas is very rare. The majority of patients presented with a cervical mass and non-specific symptoms. The most effective treatment is surgical resection. Our experience suggests sympathetic trunk Schwannomas as a differential diagnosis of slow-growing neck masses and asserts that the surgical resection is the main treatment. Conclusion The occurrence of Schwannomas in the sympathetic trunk is rare. High clinical suspicion is required to achieve the preoperative diagnosis. The optimal management is the total surgical resection. Recurrence is uncommon when the mass is totally resected.