513 - Assessing Functional Outcomes of Vagus Nerve Dysfunction Following Head and Neck Paraganglioma Resection

A 40-year-old female underwent planned surgical removal of a right carotid body paraganglioma. During the operation, her right vagus nerve was sacrificed in order to achieve complete excision. 

Post-operatively, the patient developed respiratory distress with stridor, necessitating reintubation and tracheostomy due to bilateral vocal cord dysfunction (right vocal cord paralysis, left vocal cord paresis). In the coming days, a percutaneous endoscopic gastrostomy was initially placed, which was later converted to a gastrojejunostomy tube given intolerances secondary to gastroparesis. In the weeks following, she gradually was able to tolerate clear fluids in small sips with head tilt.  After several weeks on acute inpatient rehab, she had persistent dysphonia, severe oropharyngeal dysphagia, and substantial weight loss.  


Discussions: Paragangliomas of the head and neck are rare neuroendocrine tumors originating from parasympathetic tissue, often near critical neurovascular structures. Surgical excision, particularly in the region of the vagus nerve, is associated with substantial morbidity. The vagus nerve has a prominent role in innervating the laryngeal muscles necessary for proper swallowing and speech and thus, vagus nerve resection frequently results in vocal cord paralysis that can lead to oropharyngeal dysphagia and aspiration risk. Additionally, vagal disruption often results in gastroparesis due to impaired gastric emptying, which can further complicate nutritional intake and may require adaptive enteral support. Management involves coordinated ENT, GI, and rehabilitative care to address airway, nutritional, and functional needs.  

Conclusions: Surgical resection of head and neck paragangliomas often results in complex sequelae that necessitate a comprehensive, multidisciplinary approach for effective recovery. Postoperative complications, including vagus nerve dysfunction, can lead to significant respiratory and gastrointestinal challenges. An optimal care plan should incorporate targeted respiratory and gastrointestinal management, functional rehabilitation, and coordinated follow-up with neurosurgery, ENT, and gastroenterology specialists in an outpatient setting.