Pharyngeal neurinoma
Pharyngeal neurinoma is a benign tumor—like formation that originates from nerve trunks innervating the pharynx. Symptoms of pharyngeal neurinoma will be uncomfortable sensations in the pharynx, a feeling of the presence of a foreign body and a feeling of compression. Also, among the symptoms, it is necessary to distinguish difficulty swallowing and the same breathing. Violation of nasal breathing is another indicator of a possible problem with the pharynx. In order to diagnose pharyngeal neurinoma, usually only pharyngoscopy data are used, but the diagnosis will be finally confirmed only after a histological examination conducted after a biopsy or after the removal of the neurinoma itself. As you know, the treatment of neurinoma consists, first of all, in surgical intervention. The operation takes place under local anesthesia.
The content of the article:
Causes of pharyngeal neurinoma
Symptoms of pharyngeal neurinoma
Diagnosis of pharyngeal neurinoma
Treatment of pharyngeal neurinoma
Prognosis and prevention of pharyngeal neurinoma
Pharyngeal neurinoma
As you know, pharyngeal neurinoma is a fairly rare disease. It has a neurogenic origin and originates from the peripheral branches of the sympathetic and cervical parasympathetic nerves. Pharyngeal neurinoma is not characteristic of any one age group, it can occur in a person of any age. This disease has been studied by many doctors at different times. This explains the existence of several names of the disease. So, for example, some called it neurilemoma, others attributed the name schwannoma to it, and some researchers called the disease perineural fibroblastoma. After a while, scientists agreed that all of the above names speak of two types of tumors, the first of which are based on the Schwann sheath of nerves (neurilemomas, schwannomas), while others consist of various cellular elements of nerve membranes (for example, solitary neurofibroma belongs to this type of tumor). Of course, clinical otolaryngology, in order to simplify, combined these two types of tumors under one name — pharyngeal neurinoma.
Causes of pharyngeal neurinoma
The main cause of pharyngeal neurinoma is radiation exposure. Also a common cause is the adverse effect of various chemicals on the mucous membrane of the pharynx itself. The latter include vinyl chloride, nicotine, benzanthracene and others. The same factor leads not only to the appearance of pharyngeal neurinoma in humans, but also to the appearance of bronchial adenomas, various tumors of the nasal cavity, larynx of a benign nature.
Interestingly, the occurrence and development of pharyngeal neurinoma may be a consequence of some chronic nasopharyngeal disease, for example, pharyngitis, rhinitis, tonsillitis, and so on. The latter may be associated with hypertrophic or atrophic transformation of mucosal cells due to a prolonged inflammatory process occurring in it. Genetic conditioning can also be a clear cause of the development of pharyngeal neurinoma.
Symptoms of pharyngeal neurinoma
At the beginning, the occurrence of pharyngeal neurinoma is not manifested by any clinical changes in the body. Pharyngeal neurinoma is growing very slowly, which explains the rather long asymptomatic period. As soon as the neuroma is significantly enlarged, the patient will feel discomfort, it will seem to him that some foreign body is present in the body. He will feel a squeezing and sometimes a tickling in his throat.
As a rule, the tumor is located on the back wall of the pharynx. If it is localized in the upper part of the pharynx, then the patient also has a violation of nasal breathing. If its location is the larynx, then dysphagia (violation when swallowing) is noted, as well as more difficult breathing than before.
Characteristic of pharyngeal neurinoma, which comes from sympathetic nerves, is Gorner’s syndrome, which is manifested by drooping of the upper eyelid, dilating pupils, as well as occlusion of the eyeballs. Usually, such changes with the patient take place on the side where the neurinoma is localized. If the neurinoma begins with the branches of the vagus nerve, then it is most likely that it will lead to the development of neuropathic laryngeal paresis in the future. The latter will manifest itself in various voice disorders.
Usually, when a doctor examines the pharynx, he determines what the surface of the mucous membrane is, whether there are characteristic formations located on a wide leg, which can have both a rounded and fusiform shape. With neurinoma, there is no bleeding. By feeling, the doctor reveals the density and at the same time elasticity of the tumor. Palpation of the tumor itself is painless. It should be emphasized that the neurinoma will always be in a capsule of connective tissue.
Diagnosis of pharyngeal neurinoma
It will not be difficult to diagnose pharyngeal neurinoma. This is a common thing for an otolaryngologist. The diagnosis, as a rule, can be established on the basis of an initial examination of this tumor. The latter is carried out during pharyngoscopy. In the case of parallel inflammatory processes of the nasopharynx, otoscopy, backpossing of smears, rhinoscopy are prescribed. Bakposev smears are taken from the throat and nose with the mandatory use of an antibioticogram. If the patient has a voice disorder, then a study of the voice function is also carried out, for example, phonetography, stroboscopy or electroglottography. If the case is extremely severe, then the patient is referred to an oncologist for consultation. Usually, an oncologist prescribes an endoscopic biopsy of the tumor. After conducting a histological examination, the doctor can finally confirm the nature of the tumor. However, a histology study is carried out only after the removal of the neurinoma itself. The differential diagnosis is carried out, as a rule, with the study of other possible formations (fibroids, adenomas, papillomas, cyllindromes, angiomas and others, as well as together with the study of any foreign bodies in the pharynx or even with the study of pharyngeal cancer.
Treatment of pharyngeal neurinoma
As for the treatment of pharyngeal neurinoma, then definitely only surgical intervention is necessary here. Neurinoma surgery consists in endoscopic removal of the tumor by peeling it together with the capsule in which it “sits” through an incision that the doctor conducts at the very base of the tumor formation. As a rule, the operation takes place through oral access. Anesthesia is local.
Any inflammatory disease of the nasopharynx, including pharyngeal neurinoma, needs the necessary therapy, which would be accompanied by the use of various anti-inflammatory, antibacterial, antiseptic and antihistamines. The recovery period will require the patient to perform phonopedic exercises.
Prognosis and prevention of pharyngeal neurinoma
The first thing to say about the non-tendency of neurinoma to malignancy. But if treatment is not carried out in time, the neurinoma can lead to severe respiratory disorders as soon as it reaches a large size. The latter can also cause anorexia due to swallowing disorders. Having removed the pharyngeal neurinoma, there is usually no relapse. A good prevention will be the fight against smoking, as well as effective air cleaning in industrial premises. The use of respiratory system protection in conditions of dust and pollution of the environment will also be the best way to prevent the disease. And only timely treatment of various inflammatory and infectious diseases will help prevent the occurrence of pharyngeal neurinoma.
