Paragangliomas in the head and neck are most frequently associated with the carotid artery, classically at its bifurcation and splaying the internal and external vessels. Despite their commonality at this site, large studies of these rare tumours are still lacking so consensus on when to treat these tumours is also absent. The authors of this paper describe a number of factors which need to be taken into consideration with respect to the patient (e.g. age, co-morbidities) and the tumour (e.g. size, growth rate, functioning etc.) They come to a consensus with which cases definitely require surgery, e.g. growth rate >1-2mm per year or functioning, and those that do not, e.g. elderly with other co-morbidities who undergo external beam radiotherapy as an alternative. The patients who fall between these groups clearly need careful consideration and consultation, often within an MDT setting. They then clearly describe the surgical technique used, from outlining the risks to be explained preoperatively, through the skin incision and initial dissection, followed by vessel and nerve identification prior to resection. These steps are accompanied by colour intraoperative photos and line drawings which are a considerable advantage to understanding the procedure. Postoperative considerations such as blood pressure monitoring and a full examination of the lower cranial nerves to ensure safe swallowing are also advised. Overall, a succinct and informative article regarding these types of paragangliomas. 

Treatment of carotid paraganglioma.
Myssiorek D, Persky M.
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Suzanne Jervis

FRCS (ORL HNS), Shrewsbury and Telford Hospitals, NHS Trust, UK.

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