gms | German Medical Science

Introduction: The glomus vagale tumor is a rare neoplasm, which represents 5% of the paragangliomas of the head and neck region. The tumor which usually manifests in the parapharyngeal space grows slowly and nearly asymptomatic along the vagal nerve. In most cases complaints and clinical signs are reported only at an advanced tumor stage.

Case report: A male aged 22 years presented with slowly progressing dysphagia. Endoscopy revealed a bulging of the right soft palate and lateral pharyngeal wall. CT-scan and MRI showed a vascular tumor which extended from the carotid bifurcation to the skull base and which surrounded and compressed the internal carotid artery. Angiography showed that the tumor was vascularized by branches from the vertebral artery and the external carotid artery. Carotid balloon occlusion test indicated a sufficient collateral cerebral blood flow. Thus preoperatively besides embolisation of the arterial vessels supplying the tumor, the internal carotid artery was coiled intracranially. Via a combined transmandibular, transoral and transcervical approach a radical tumor resection was performed. The internal carotid artery, the vagal nerve and the sympathetic nerve, which were infiltrated by the tumor, were included into the resection. The remaining caudal cranial nerves could be saved. Pathological examination revealed a vagal paraganglioma. After surgery the patient showed a slight partial left-sided hemiparesis, an ipsilateral vocal cord paresis and a mild dysphagia. Except the vocal cord paresis, within the further postoperative course these complaints showed a tendency to subside.

Conclusion: Vagal paragangliomas usually grow asymptomatic until an advanced tumor stage is reached. The treatment of first choice is radical surgical resection of the tumor after embolisation. In very large tumors a combined transmandibular transoral and transfacial approach is recommended. In case of an extensive involvement of the internal carotid artery and a positive ballon occlusion test it can become neccesary to ligate and to resect the vessel.