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Clinical Note |

Undescended Parathyroid Adenoma Arising Within the Hypoglossal Nerve

Jim Nguyen, BS; Ontario Lau, MD; Elliot Abemayor, MD, PhD; Michael W. Yeh, MD
Arch Otolaryngol Head Neck Surg. 2011;137(7):709-711. doi:10.1001/archoto.2011.90.
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Ectopic parathyroid adenomas are found in up to 16% of initial operations1 and 50% of reoperations2 for primary hyperparathyroidism. A small fraction of ectopic glands are located well outside the bounds of a conventional low cervical Kocher-type exposure. Examples include mediastinal adenomas, which are generally inferior glands embryologically, and undescended superior adenomas. Undescended superior parathyroid glands are found in fewer than 0.1% of cases and are defined as glands that are located 1 cm or more cephalic to the upper pole of the thyroid gland.3 They may be found along or within the pharyngeal wall and almost never lie above the carotid bifurcation. Intraneural parathyroid adenomas are distinctively rare. We report the second published case (to our knowledge) of an ectopic parathyroid adenoma arising within the hypoglossal nerve.

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Figure 1. Magnetic resonance image of the neck showing a 9.8-mm lesion in the right submandibular region deep to the parotid gland and immediately lateral to the right cervical internal carotid artery at the plane of the C1 lateral mass.

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Figure 2. Exposure of the ectopic parathyroid adenoma arising from the proximal portion of the hypoglossal nerve near the skull base and immediately adjacent to the right cervical internal carotid artery.

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