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Related to carotid sheath: recurrent laryngeal nerve
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Careful dissection freed the tumor from the facial nerve laterally, the carotid sheath anteriorly, and the skull base superiorly.
The muscle was wedged between the carotid sheath antero-medially; and the brachial plexus and scalenus medius postero-laterally as shown in Figure 2.
Most patients with cervical primary lesions present with a welldefined mass posterior to the carotid sheath vessels with or without intraspinal extension and with or without calcification.
The large mass identified on axial imaging was anatomically located within the left anterior cervical space; the boundaries of which are formed by all three layers of the deep cervical fascia before they converge; forming the carotid sheath posteriorly (1) (Figure.
When ectopic, parathyroid glands can be located from the carotid sheath to the mediastinum to the inferior aspect of the heart.
The carotid artery was draped over the mass, so the carotid sheath was opened and the artery was mobilized off the front of the mass.
It is expected that these tumours will have the same intrinsic imaging characteristics, as they have the same histological basis, however it is unusual for a vagal paraganglioma to arise within the carotid sheath at the point of the carotid bifurcation.