Carotid Body Tumours (Paragangliomas)
Carotid body tumours (CBTs), also known as carotid body paragangliomas or chemodectomas, are rare growths that occur at the point where the carotid artery divides in the neck. These tumours arise from specialised chemoreceptor cells responsible for regulating blood oxygen and carbon dioxide levels. Most CBTs are benign and slow-growing, but untreated tumours may affect nearby nerves and blood vessels.
History & Definition
The carotid body has been recognised in medical literature since the 1700s. Carotid body tumours are the most common paragangliomas of the head and neck and belong to a group of rare neuroendocrine tumours. Though uncommon (approximately 1 in 30,000 people), their close proximity to vital structures makes specialised care essential.
Causes & Risk Factors
- Genetic Factors: About 10% of cases are familial, often linked to SDH gene mutations.
- Chronic Low Oxygen Levels: Higher incidence in individuals living at high altitudes.
- Age & Gender: More common in middle-aged adults, with slight female predominance.
In India, CBTs are typically diagnosed at tertiary care centres, often presenting as painless neck swellings requiring multidisciplinary management.
Symptoms
- Painless lump on the side of the neck
- Pulsatile neck swelling
- Hoarseness of voice
- Difficulty swallowing
- Cranial nerve-related symptoms
Diagnosis
- Ultrasound with Doppler to assess vascularity
- CT or MRI angiography for surgical planning
- Angiography in selected cases
- Shamblin classification to assess surgical complexity
Treatment Options
Surgical Excision
Surgery is the primary and most effective treatment, especially for growing or symptomatic tumours. Advanced microsurgical techniques help preserve nerves and blood vessels. Preoperative embolisation may be used for large tumours.
Radiation Therapy
Radiotherapy may be considered for patients who are not suitable surgical candidates or when complete excision is not feasible.
Observation
Small, asymptomatic tumours may be closely monitored with periodic imaging.
Recent Advances
- High-resolution imaging and vascular mapping
- Preoperative embolisation to reduce blood loss
- Nerve-preserving surgical techniques
- Genetic testing for familial cases
Possible Complications
- Cranial nerve injury (temporary or permanent)
- Vascular injury or bleeding
- Rare risk of stroke
- Wound healing issues
Outcomes
Long-term outcomes are generally excellent, with tumour control rates of 90–95% after complete surgical removal. Most patients recover well and maintain a good quality of life with appropriate follow-up.
Conclusion
Carotid body tumours are rare but important head and neck conditions that require accurate diagnosis and expert management. With advances in imaging, surgical techniques, and multidisciplinary care, treatment outcomes are highly successful, ensuring patient safety and long-term tumour control.