A CASE OF POST-OPERATIVE DYSPHAGIA IN A CHILD WITH RETROPHARYNGEAL SCHWANNOMA
The patient was a 14-year-old child who complained suddenly of pain of the left ear and underwent a check-up at the general hospital. The doctor found swelling of the left peri-tonsillar area and CT examination showed a retropharyngeal tumor. He was subsequently referred to our hospital for further...
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| Published in | JIBI INKOKA TEMBO Vol. 65; no. 5; pp. 200 - 206 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Society of Oto-rhino-laryngology Tokyo
15.10.2022
耳鼻咽喉科展望会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-9687 1883-6429 |
| DOI | 10.11453/orltokyo.65.5_200 |
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| Abstract | The patient was a 14-year-old child who complained suddenly of pain of the left ear and underwent a check-up at the general hospital. The doctor found swelling of the left peri-tonsillar area and CT examination showed a retropharyngeal tumor. He was subsequently referred to our hospital for further examination.Cervical enhanced CT and MRI showed a 38mm round tumor in the retropharyngeal space. We consulted with radiologists, pediatricians and plastic surgeons about the diagnosis and treatment. We decided to perform surgery via a trans-cervical approach, considering the potential for malignant tumors, such as rhabdomyosarcoma and synovial sarcoma. The pathological diagnosis was schwannoma.Severe dysphagia due to glossopharyngeal nerve palsy and vagus nerve palsy occurred post-operatively, but recovered with rehabilitation.Schwannoma is often seen as a cause for cervical tumor, but cases of retropharyngeal schwannoma in children are extremely rare. |
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| AbstractList | The patient was a 14-year-old child who complained suddenly of pain of the left ear and underwent a check-up at the general hospital. The doctor found swelling of the left peri-tonsillar area and CT examination showed a retropharyngeal tumor. He was subsequently referred to our hospital for further examination.Cervical enhanced CT and MRI showed a 38mm round tumor in the retropharyngeal space. We consulted with radiologists, pediatricians and plastic surgeons about the diagnosis and treatment. We decided to perform surgery via a trans-cervical approach, considering the potential for malignant tumors, such as rhabdomyosarcoma and synovial sarcoma. The pathological diagnosis was schwannoma.Severe dysphagia due to glossopharyngeal nerve palsy and vagus nerve palsy occurred post-operatively, but recovered with rehabilitation.Schwannoma is often seen as a cause for cervical tumor, but cases of retropharyngeal schwannoma in children are extremely rare.
神経鞘腫は末梢神経Schwann細胞由来の被膜を有する境界明瞭な良性腫瘤で，頸部腫瘤の原因としてはしばしば認められるが，小児における咽頭後間隙神経鞘腫の治療例は本邦では報告例がない。症例は14歳男児。当院初診の14日前頃に断続的な左耳痛を自覚し近医耳鼻咽喉科を受診したところ，咽頭後壁左側の腫脹を認めたため精査目的に近医大学病院を紹介受診した。CT検査にて咽頭後間隙腫瘤を認め，精査加療目的にx日に当院に紹介受診となった。造影CT，造影MRI検査を施行したところ，中咽頭後壁左側に内部不均一で一部造影効果を伴う境界明瞭辺縁平滑な最大縦径38mm大の腫瘤性病変を認めた。術前診断としては迷走神経や舌咽神経由来の神経鞘腫などの良性腫瘍も疑われたものの，受診の1週間程度前からいびきの増大を家族から指摘されるなど，急速に増大している可能性が否定できず，横紋筋肉腫や滑膜肉腫等の悪性疾患も考慮されたため，小児科，放射線科，形成外科と協議し，頸部外切開にて腫瘍の全摘出術を行う方針とした。術後の病理組織検査では，神経鞘腫の診断であった。術後重度な嚥下障害を認めたが，嚥下リハビリテーションにより改善を認めた。本症例のように，悪性疾患（特に肉腫）が疑われる場合は被膜間摘出が困難であるため，術前に神経脱落症状についての十分な説明と同意が重要であると考えた。 The patient was a 14-year-old child who complained suddenly of pain of the left ear and underwent a check-up at the general hospital. The doctor found swelling of the left peri-tonsillar area and CT examination showed a retropharyngeal tumor. He was subsequently referred to our hospital for further examination.Cervical enhanced CT and MRI showed a 38mm round tumor in the retropharyngeal space. We consulted with radiologists, pediatricians and plastic surgeons about the diagnosis and treatment. We decided to perform surgery via a trans-cervical approach, considering the potential for malignant tumors, such as rhabdomyosarcoma and synovial sarcoma. The pathological diagnosis was schwannoma.Severe dysphagia due to glossopharyngeal nerve palsy and vagus nerve palsy occurred post-operatively, but recovered with rehabilitation.Schwannoma is often seen as a cause for cervical tumor, but cases of retropharyngeal schwannoma in children are extremely rare. |
| Author | Sakuma, Nobuyuki Shimura, Eiji Kuroda, Kento Kessoku, Hisashi Kojima, Hiromi |
| Author_FL | 小島 博己 黒田 健斗 結束 寿 佐久間 信行 志村 英二 |
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| References | 13) 三輪高喜，室野重之，塚谷才明，他：画像上嚢胞性に描出される頭頸部病変の鑑別診断．頭頸部外科 15: 93–101, 2005. 19) Matthew DJ, Guha-Thakurta N: Retropharyngeal and prevertebral spaces: anatomic imaging and diagnosis. Otolaryngol Clin North Am 45: 1293–1310, 2012. 18) Wong YK, Novotny GM: Retropharyngeal space—a review of anatomy, pathology, and clinical presentation. J Otolaryngol 7: 528–536, 1978. 6) Lin CC, Wang CC, Liu SA, et al: Cervical Sympathetic Chain Schwannoma. J Formos Med Assoc 106: 956–960, 2007. 22) Gallo S, Bandi F, Maffioli MP, et al: Retropharyngeal space schwannoma: A rare entity. Iranian J Otorhinolaryngol 29: 353–357, 2017. 4) Thurnher D, Quint C, Pammer J, et al: Dysphagia due to a large schwannoma of oropharynx. Arch otolaryngol Head Neck Surg 128: 850–852, 2002. 14) Saito DM, Christine M, Glastonbury M, et al: Parapharyngeal space schwannomas preoperative imaging determination of the nerve of origin. Arch Otolayngol Head Neck Surg 133: 662–667, 2007. 16) Sweasy T, Edelstein S, Hoff J: Glossopharyngeal schwannoma: review of five cases and the literature. Surg Neurol 35: 127–130, 1991. 1) Enzinger FM, Weiss SW: Soft tissue tumors-Third Edition. St. Louis, Mosby, 1995, 821–888. 9) Abou-Elfadl M, Lrhazi S, Mahtar M, et al: Unusual retropharyngeal mass. Eur Ann Otorhinolaryngol Head Neck Dis 132: 115–116, 2015. 23) Ngu CYV, Gan CG, Tang IP: Transoral excision of retropharyngeal schwannoma: Case report. Acta Oto-laryngologica Cases Report 2: 64–67, 2017. 26) 吉田尚生，田中信三，平塚康之，他：咽頭神経叢を温存するルビエールリンパ節郭清術．日耳鼻 122: 225–229, 2019. 25) Moore KL, Dalley AF：臨床のための解剖学 第1版第4刷．佐藤達夫，坂井建雄 監訳：メディカル・サイエンス・インターナショナル，東京，2013, 1120–1125. 2) Colreavy MP, Lacy PD, Hughes J, et al: Head and neck schwannomas—a 10 year review. J Laryngol Otol 114: 119–124, 2000. 8) 尾尻博也：頸部神経鞘腫の画像所見と臨床．耳展 54: 44–45, 2011. 5) Chia YH, Jong KH, Cheng PW: Retropharyngeal schwannoma excised through a transoral approach: a case report. Kaohsiung J Med Sci 22: 465–469, 2002. 3) Kanatas A, Mucke T, Houghton D, et al: Schwannomas of the head and neck. Oncol Rev 3: 107–111, 2009. 10) Hsieh CY, Hsiao JK, Wang CP: Retropharyngeal schwannoma excised through a transoral approach: A case report. Kaohsiung J Med Sci 22: 465–469, 2006. 12) Huang CM, Leu YS: Schwannoma of the posterior pharyngeal wall. J Laryngol Otol 116: 740–741, 2002. 21) Kumagai M, Endo S, Shiba K, et al: Schwannoma of the retropharyngeal space. Tohoku J Exp Med 210: 161–164, 2006. 17) 片岡真吾，川内秀之：神経鞘腫の悪性化について―文献的考察．頭頸部外科 17: 113–117, 2007. 24) Baker EW：プロメテウス解剖学アトラス 口腔・頭頸部 第1版第3刷．坂井建雄，天野 修 監訳：医学書院，東京，2016, 212–217. 11) 森本まり，坂本 裕，小川 郁，他：咽頭後間隙脂肪肉腫の一症例．耳喉頭頸 63: 725–730, 1991. 7) Righini CA, Atallah I: A retropharyngeal mass. Diagnosis: antoni A type schwannoma. Eur Ann Otorhinolaryngol Head Neck Dis 132: 57–58, 2015. 15) 橋本 省：神経鞘腫に対する被膜間摘出術のコンセプト．頭頸部外科 17: 91–92, 2007. 20) John GB, Nour S: Parapharyngeal and retropharyngeal space disease. Ann Otol Rhinol Laryngol 98: 320–321, 1989. |
| References_xml | – reference: 9) Abou-Elfadl M, Lrhazi S, Mahtar M, et al: Unusual retropharyngeal mass. Eur Ann Otorhinolaryngol Head Neck Dis 132: 115–116, 2015. – reference: 2) Colreavy MP, Lacy PD, Hughes J, et al: Head and neck schwannomas—a 10 year review. J Laryngol Otol 114: 119–124, 2000. – reference: 1) Enzinger FM, Weiss SW: Soft tissue tumors-Third Edition. St. Louis, Mosby, 1995, 821–888. – reference: 6) Lin CC, Wang CC, Liu SA, et al: Cervical Sympathetic Chain Schwannoma. J Formos Med Assoc 106: 956–960, 2007. – reference: 21) Kumagai M, Endo S, Shiba K, et al: Schwannoma of the retropharyngeal space. Tohoku J Exp Med 210: 161–164, 2006. – reference: 18) Wong YK, Novotny GM: Retropharyngeal space—a review of anatomy, pathology, and clinical presentation. J Otolaryngol 7: 528–536, 1978. – reference: 15) 橋本 省：神経鞘腫に対する被膜間摘出術のコンセプト．頭頸部外科 17: 91–92, 2007. – reference: 17) 片岡真吾，川内秀之：神経鞘腫の悪性化について―文献的考察．頭頸部外科 17: 113–117, 2007. – reference: 19) Matthew DJ, Guha-Thakurta N: Retropharyngeal and prevertebral spaces: anatomic imaging and diagnosis. Otolaryngol Clin North Am 45: 1293–1310, 2012. – reference: 24) Baker EW：プロメテウス解剖学アトラス 口腔・頭頸部 第1版第3刷．坂井建雄，天野 修 監訳：医学書院，東京，2016, 212–217. – reference: 3) Kanatas A, Mucke T, Houghton D, et al: Schwannomas of the head and neck. Oncol Rev 3: 107–111, 2009. – reference: 20) John GB, Nour S: Parapharyngeal and retropharyngeal space disease. Ann Otol Rhinol Laryngol 98: 320–321, 1989. – reference: 22) Gallo S, Bandi F, Maffioli MP, et al: Retropharyngeal space schwannoma: A rare entity. Iranian J Otorhinolaryngol 29: 353–357, 2017. – reference: 11) 森本まり，坂本 裕，小川 郁，他：咽頭後間隙脂肪肉腫の一症例．耳喉頭頸 63: 725–730, 1991. – reference: 4) Thurnher D, Quint C, Pammer J, et al: Dysphagia due to a large schwannoma of oropharynx. Arch otolaryngol Head Neck Surg 128: 850–852, 2002. – reference: 7) Righini CA, Atallah I: A retropharyngeal mass. Diagnosis: antoni A type schwannoma. Eur Ann Otorhinolaryngol Head Neck Dis 132: 57–58, 2015. – reference: 26) 吉田尚生，田中信三，平塚康之，他：咽頭神経叢を温存するルビエールリンパ節郭清術．日耳鼻 122: 225–229, 2019. – reference: 14) Saito DM, Christine M, Glastonbury M, et al: Parapharyngeal space schwannomas preoperative imaging determination of the nerve of origin. Arch Otolayngol Head Neck Surg 133: 662–667, 2007. – reference: 10) Hsieh CY, Hsiao JK, Wang CP: Retropharyngeal schwannoma excised through a transoral approach: A case report. Kaohsiung J Med Sci 22: 465–469, 2006. – reference: 5) Chia YH, Jong KH, Cheng PW: Retropharyngeal schwannoma excised through a transoral approach: a case report. Kaohsiung J Med Sci 22: 465–469, 2002. – reference: 23) Ngu CYV, Gan CG, Tang IP: Transoral excision of retropharyngeal schwannoma: Case report. Acta Oto-laryngologica Cases Report 2: 64–67, 2017. – reference: 12) Huang CM, Leu YS: Schwannoma of the posterior pharyngeal wall. J Laryngol Otol 116: 740–741, 2002. – reference: 25) Moore KL, Dalley AF：臨床のための解剖学 第1版第4刷．佐藤達夫，坂井建雄 監訳：メディカル・サイエンス・インターナショナル，東京，2013, 1120–1125. – reference: 13) 三輪高喜，室野重之，塚谷才明，他：画像上嚢胞性に描出される頭頸部病変の鑑別診断．頭頸部外科 15: 93–101, 2005. – reference: 8) 尾尻博也：頸部神経鞘腫の画像所見と臨床．耳展 54: 44–45, 2011. – reference: 16) Sweasy T, Edelstein S, Hoff J: Glossopharyngeal schwannoma: review of five cases and the literature. Surg Neurol 35: 127–130, 1991. |
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| SubjectTerms | children dysphagia pharyngeal plexus retropharyngeal tumor schwannoma 咽頭後間隙腫瘍 咽頭神経叢 嚥下障害 小児 神経鞘腫 |
| Title | A CASE OF POST-OPERATIVE DYSPHAGIA IN A CHILD WITH RETROPHARYNGEAL SCHWANNOMA |
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