This document summarizes 3 cases of head and neck tumors seen at KBTH from 2012-2016. The first case was a 38-year-old female with a bilateral carotid body tumor who underwent excision of the left tumor, resulting in injuries to cranial nerves X and XII. The second case was a 42-year-old female with a vagal schwannoma who underwent excision, resulting in cranial nerve X palsy. The third case was a 32-year-old female found to have both an acoustic neuroma and glomus jugulare based on symptoms and imaging, who was scheduled to undergo radiotherapy.

1. paraganglioma
Case presentation
Dr Eunice Rabiatu Abdulai
05/12/16

2. STATISTICS KBTH 2012-2016
year Age sex diagnosis Number of cases treatment
2014 38 F Bilateral 1 Excision of the left tumour (injury
to CN X and XII)
and radiotherapy for the right
tumour (yet to start)
2015 42 F Vagal schwanoma 1 Excision (injury to CNX)
2016 32 F Glomus jugularis
+acoustic neuroma
1
Radiotherapy (yet to start)
TOTAL NUMBER 3

3. • Name: J T
• Age:38
• Sex: F
• Occupation: Teacher
• NHIS: yes
• Marital status: married

4. Presenting complain
Intermittent Left ear pain: 10years
Intermittent dyspnoea: 2years
Bilateral neck swelling: 3 month

5. History of presenting complaint
•Patient was well until 10yrs ago she started
experiencing intermittent left ear arch which she
sent to several hospital but it was not getting
better. Few months prior to presentation, she
notice she had bilateral neck mass and
complained to her doctor at LA general hospital
who referred her to ENT, KBTH.

6. • On Direct Questioning
She did not have
Dysphagia,
odynophagia,
easy fatigability,
otorrhoea,
aural fullness,
tinnitus ,
hearing loss,
vertigo ,
• nasal congestion,
• rhinorrhea,
• epistasis ,
• epiphora ,
• diplopia,
• headache,
• weight loss,
• night sweats,
• excessive sweating,
• palpitations

7. Past Medical And Surgical History
• She does not have
• Hypertension
• DM
• TB
• ASTHMA
• Past surgeries
• Past hemo transfusion
• But has
• Allergies to dust

8. Family History
• No family history of
• Hypertension
• Diabetes
• cancers

9. Social history
• Teacher ,
• married with 2 children,
• does not drink alcohol or smoke cigarate

10. Clinical examination
• General:
• Looks well, not pale or jaundice
• Ears:
• Nose: NORMAL FINDINGS
• Oropharynx:
• IDL
• Head and neck
• Bilateral Firm fixed swellings to the underlying tissues measuring about 3 by 4cm on
the right and 3 by 2cm on left
• All cranial nerves were intact
• Auscultation: carotid bruit

11. diagnosis
• Bilateral Carotid body tumour
•

12. OTHER Systemic Examination
• CVS:
• CHEST: normal
• ABDOMEN:
• CNS:

13. INVESTIGATIONS (C T scan showed)

17. Angiogram

18. INVESTIGATIONS
• 24 HR urine collection for catecholamine's: normal
• Histopathology after left carotid body excision: confirmed our
diagnosis

19. Other investigations
• FBC
• Sickling and HB electrophoreses
• Clotting profile
• ESR
• BUN Cr & Electrolytes
• LFT
• CHEST
• ECG
• ANAESTHETIC ASSESSMENT

20. TREATMENT
• Surgical resection was done
• COPLICATION
• Injury to CN X, CNXII

21. procedure
• Surgery ; left carotid body Excisional biopsy
• Anaesthesia : GA
• Position: supine with sand bag in between the shoulders and head turned to the opposite side of the lesion
• Incision: left horizontal incision at the at the thyroid cartilage from midline to posterior border of SCM
• Raised sub platysmal flap to above the hyoid superiorly and inferiorly
• incision of the ipsilateral deep investing fascia to separate SCM muscle from strap muscles
• SCM are retracted laterally to expose IJV & carotid sheet
• Carotid sheath is entered
• Proximal and distal control with vessel loops
• Identification and preservation of neural structures if possible(Tumour was dissected out whiles trying to preserve CNX & CNXII
which were imbedded in tumour )
• Prepare for vascular reconstruction if necessary(suture repair , patch grafting , interposition saphenous vein graft) :
• routine shunting not recommended and is used on when balloon occlusion fails(vascular complication 6.4%, mortality 1.6%)
• Haemostasis secured
• Suction drain pass into the wound and secured
• Skin closed in 2 layers
• Histopathology :left neck carotid tumour

22. 2nd case
• A. S is a 42year old who
presented with a 3 years history
of anterolateral mass which grew
gradually in size to about 6 ₓ6ₓ
5cm at presentation.
• she had FNAC at general surgery
which came as spindle cell
tumour(most likely benign) b4
she was referred to ENT for
further management.

23. CT- scan

24. CT- scan

25. treatment
• Surgery ; Neck Exploration +Excisional biopsy
• Anaesthesia : GA
• Position: supine with sand bag in between the shoulders and head turned to the opposite side
of the lesion
• Incision: 2cm above the sternal notch extending from one anterior border of one SCM to the
other
• Raised sub platysmal flap to above the hyoid superiorly and to sternal notch and clavicle
inferiorly
• incision of the ipsilateral strap muscles
• Tumour was dissected out
• Haemostasis secured
• Suction drain pass into the wound and secured
• Incised Strap muscles suture
• Skin closed in 2 layers
• COMPLICATION: CNX PALSY
• Histopathology :right neck schwannoma

26. Intraoperative
Cystic
elliptical
mass ≈ 9cm
ₓ7cmₓ6cm
Attached to
the vagus
nerve

27. 3rd case
• F.A is a 32years old F who presented with persistent unremitting hoarseness
and right otalgia for 8months, with right hearing loss for 3months duration
.she also coughs when she eats dry food like yam and bread.
• She had rising sun sign on otoscopy of right ear(reddening of lower part of
tympanic membrane) and severe to profound hearing loss on clinical voice
test , right vocal cord palsy on flexible laryngoscopy and involvement right
cranial nerve VI,VIII & X .
• Pure tone audiometry confirmed the clinical voice test
•

28. otoscopy of right ear(reddening of lower part of
tympanic membrane)

29. right vocal cord palsy on flexible laryngoscopy

30. CT-Scan
• ACOUSTIC NEUROMA
• GLOMUS JUGULARE

31. ww