Introduction
Vagal schwannomas are rare peripheral nerve sheath tumors arising from the vagus nerve.1 Typically diagnosed in adulthood at a median age of 44 years,2 pediatric vagal schwannomas are exceedingly uncommon. Tumors may arise intracranially or extracranially, with the parapharyngeal space being the most common extracranial site in the head and neck.3
Surgical resection remains the treatment of choice for vagal schwannomas. Described operative techniques include gross total resection or intracapsular enucleation. However, the merits of either approach are dependent on the lesion size, location and baseline nerve function.
We describe herein an unusual case of a young girl presenting with a large vagal schwannoma with an associated hypoglossal nerve palsy necessitating a combined transcervical-mandibulotomy approach for total tumor resection. The presentation is unique due to the size of the lesion, the patient’s age, the operative approach required, as well as the paralysis of a cranial nerve that was not its nerve of origin.