Cervical sympathetic schwannoma with postoperative first bite syndrome

Kamal, Alsharawy; El-Fattah, Ahmed Musaad Abd; Tawfik, Ali; Razek, Ahmed Abdel Khalek Abdel

doi:10.1007/s00405-007-0308-y

Cited by 26 publications

(23 citation statements)

References 5 publications

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“…Treatment involves dietary modiWcations [6,8,10,12,13], drug therapy [1, 4, 5, 8-10, 12, 13], or even surgery [1,[4][5][6], with only partial control in most cases [1,5,8]. Total recovery may occur, but is exceptional [4,6,9].…”

Section: Introductionmentioning

confidence: 99%

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First-bite syndrome in oncologic patients

Costa

Araujo

Filipe

et al. 2011

Eur Arch Otorhinolaryngol

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First-bite syndrome (FBS) is described as a complication of parapharyngeal space surgery and consists of short-term pain in the parotid or mandibular region at the start of each meal, usually on the first bite and improving with subsequently each bite. The pathogenesis is related to a selective sympathetic denervation of the parotid gland and its treatment involves dietary modifications, medical treatment or even surgery, all with poor results. FBS is often undervalued and misdiagnosed, yet it is a pathology that may interfere with the patient's quality of life. We report two patients who underwent major cervical oncologic surgeries. One patient was subject to extended radical neck dissection into the parapharyngeal space and the other patient ligation of the external carotid artery, which post-operatively developed into FBS unresponsive to the medical treatment instituted. During external adjuvant radiotherapy, both had an unexpected FBS improvement, remaining asymptomatic after 7 and 10 months of follow-up. In this study, we discuss why FBS is misdiagnosed in oncologic patients, the possible pathophysiological mechanisms of radiotherapy and its plausibility as a new modality of treatment in selected cases.

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Section: Introductionmentioning

confidence: 99%

“…First-bite syndrome (FBS) is classically described as a complication of parapharyngeal space surgery, such as the resection of the carotid body or vagal paragangliomas, schwannomas, resection of the styloid process in Eagle's syndrome, pleomorphic adenoma or lymphangioma [1][2][3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

First-bite syndrome in oncologic patients

Costa

Araujo

Filipe

et al. 2011

Eur Arch Otorhinolaryngol

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“…They are notoriously difficult to diagnose as history and clinical examination are non specific. In the head and neck, these tumours are often mistaken for other lesions such as enlarged lymph nodes, carotid body tumours, branchial cysts, or thyroid lesions (2,3). Imaging in the form of CT scan and MRI are helpful in providing some suspicion of a schwannoma (4).…”

Section: Discussionmentioning

confidence: 99%

Schwannoma of the ansa cervicalis

Okonkwo

Doshi

Minhas

2011

Journal of Surgical Case Reports

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Schwannomas are rare neoplasms that originate from Schwann cells. We present a case report of schwannoma of the ansa cervicalis in a patient where preoperative imaging suggested thyroid pathology.A 25-year-old man presented to the otolaryngology department with a one-year history of an asymptomatic, anterior triangle neck swelling. Imaging and FNA suggested a cystic lesion of the thyroid. However, intraoperatively, the lesion was found between the right sternohyoid and thyrohoid and histology showed findings consistent with a diagnosis of schwannoma, determined to originate from the ansa cervicalis based on its anatomical position.Schwannoma of the ansa cervicalis is extremely rare and there have only been four reported cases in the literature. Schwannomas are often misdiagnosed and confused for other lesions. In our case report we add to the sparse literature on this pathology and highlight common pitfalls in diagnosis and discuss the principles of management of this rare condition.

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“…16 e pain gradually lessens with subsequent mastication, but is nonetheless as painful upon taking the first bite of the next meal. 15 e symptoms of the patient presented in Case 1 are remarkably analogous to the description of this syndrome.…”

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confidence: 99%

“…In the study, 6 patients had undergone resection of the sympathetic chain, and the external carotid artery had been ligated inferior to the parotid gland in the remaining 6 patients. 16 All cases seem to suggest interrupted sympathetic innervation as the underlying cause of first-bite syndrome in these patients.…”

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confidence: 99%