Ear, Nose & Throat Journal2023, Vol. 102(12) 759–761© The Author(s) 2021Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/01455613211031027journals.sagepub.com/home/ear
We present a rare case of a schwannoma which is localized on the posterior pharyngeal wall. It caused severe difficulty in swallowing and breathing in a 3-year-old child. Schwannomas of the posterior pharyngeal wall have been rarely reported in children. To our knowledge, only 7 cases of posterior pharyngeal wall schwannoma have been previously reported in the literature, but none of them is associated with a child. The tumor was removed with plasma radiofrequency excision via a transoral route. Computed tomography or magnetic resonance imaging examination showed no recurrence of the tumor up to 2 years. To our knowledge, for the first time, a case of posterior pharyngeal wall schwannoma has been reported in a 3-year-old child, and the schwannoma was removed via plasma radiofrequency transoral excision. This case study illustrates that schwannoma may occur in children, and it is safe to treat this disease through plasma radiofrequency transoral excision route.
Keywordsschwannoma, dyspnea, posterior pharyngeal wall, plasma radiofrequency transoral excision
Schwannomas may present along any somatic or sympathetic nerve, due to its anatomical compartmentalization of neural structures. The head and neck region presents a frequent site for the occurrence of these tumors, accounts for approximately 25% to 45% of all cases of schwannoma.1 Although they are among the most common benign tumors of the parapharyngeal space, their rate of incidence in children on the posterior pharyngeal all is extremely rare. No such case has recently been reported in the literature yet. The objective of this article is to present one such case and discuss its treatment.
Because of progressive dysphagia and respiratory disturbance, a 3-year-old child visited our hospital to seek medical attention. On clinical examination, a round mass was found to be protruding from the left posterior wall of the pharynx. Flexible fiberoptic endoscopy identified a pedunculated lesion that measured approximately 2.5 × 1.5 cm arising from the posterior pharyngeal wall. The mass occupied part of the supraglottic area and caused the symptom of dyspnea (Figure 1). Computed tomography of the neck revealed a soft tissue, protruding from the posterior wall of the pharynx (Figure 2). Further physical examination revealed the presence of characteristic café-au-lait spots around the patient’s abdomen (Figure 3).
Based on the aforementioned clinical and radiological findings, a complete plasma radiofrequency excision of the mass was performed via a transoral route. The child experienced only slight intraoperative bleeding, which was easily controlled. Little adhesion was found between the tumor and the pharyngeal mucosa, and there was no nerve connected to the tumor. The cut surface showed tan and white areas. No necrosis was detected. Histological examination confirmed the diagnosis of schwannoma.
This patient recovered well with no damage reported to cranial nerves IX and X. Dysphagia and respiratory disorder were improved after the operation. One week post excision, a flexible fiberoptic examination showed complete healing of the mucosal surface and no signs of persistence. No recurrence of schwannoma was reported after a 2-year follow-up.
Schwannoma is a benign, isolated, encapsulated tumor that can occur anywhere in the peripheral nervous system. Its incidence in the head and neck is 25% to 45%. The most common site of head and neck schwannoma is the parapharyngeal space, and the vagus nerve is the most common site of origin. Very rarely, a child develops a schwannoma in the posterior wall of the pharynx.
Schwannomas are normally asymptomatic. The symptoms that cause our patients to seek medical attention develop from cosmetic malformations or tumors that interfere with certain functions, as in the current case. When they compress adjacent structures, they slowly grow and produce symptoms and signs. When they are located in the pharynx, they cause breathing difficulties, dysphagia, and other symptoms associated with the origin nerve.2
When the tumor occupies part of the supraglottic area, we should consult an anesthesiologist before surgery to evaluate the difficulty degree of tracheal intubating. Tracheal intubation should be performed by an experienced anesthesiologist. If there is some question about the difficulty of intubation, fiberoptic bronchoscopy intubation or tracheotomy should be performed in advance.
Based on the available literature3,4 and considering topographic data and the lack of signals from the ninth and tenth nerves, we can assume that in our case, neuroblastoma also originated in the parapharyngeal plexus.5
The choice of treatment is complete surgical excision. The safest surgical entry path for parapharyngeal schwannoma is the external path, while transoral excision is better for pharyngeal tumors. However, in this method, the limited risk of surgical exposure and bleeding must be considered. The use of plasma radiofrequency excision is safe and effective. It allows for clear edges and minimizes inoperative bleeding. After surgery, no recurrence and no damage were reported to cranial nerve function.
P.Z. conception of the work, acquisition, analysis, and interpretation of data for the work, revision of work for important intellectual content, final approval of version to be published, agreement to be accountable for all aspects of work. X.Y.L. acquisition, analysis, and interpretation of data for the work, revision of work for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of work. All data generated or analyzed during this study are included in this published article. The portrayal of clinical data and images in this study were signed with informed consent, which was obtained on behalf of the patient from the legal guardian. Ethics approval and consent to participate: The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Shanghai Children’s Hospital, Shanghai Jiao Tong University.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
1 Department of Otorhinolaryngology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
Received: June 04, 2021; revised: June 16, 2021; accepted: June 21, 2021
Corresponding Author:Xiao Yan Li, PhD, Department of Otorhinolaryngology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Lu Ding Lu 355 Hao, Pu Tuo Qu, Shanghai, China.Email: 1474939647@qq.com