Lump under the angle of the jaw
A lump on the side of the neck that does not hurt and grows slowly.
CONDITION / JAWS, MOUTH AND NECK
Hemodectoma (paraganglioma) of the neck.
Hemodectoma of the neck is a rare tumor of the carotid body, a tiny cluster of cells where the carotid artery divides into two branches. It is mostly benign and slow-growing, but lies on large vessels and near nerves, so treatment decisions are made carefully.
CONCEPTUAL VISUALIZATION- What it is
- A rare tumor from the cells of the carotid body at the branching point of the carotid artery.
- How it presents
- Most often, there is a swelling on the side of the neck at the angle of the jaw, which does not hurt.
- Heredity
- In a pooled analysis of 9,291 patients, SDH gene changes were 36%.
- Who treats it
- Team: surgeon, endocrinologist, geneticist, radiation therapist.
01 / WHAT IS ITWhat is
What is
neck chemodectoma.
Hemodectoma, or paraganglioma, is a rare neuroendocrine tumor. On the neck, it grows from the carotid body — a small cluster of cells in the place where the common carotid artery divides into the internal and external. Such tumors also occur on the vagus nerve or near the ear.
For the most part, chemodectoma is benign and grows slowly. In a cohort of 159 head and neck tumors, over a median follow-up of 63.6 months, 44% increased, and carotid body tumors grew at a median rate of 1.6 mm per year. Malignancy is rare: in a pooled analysis of 155 studies, 6% of tumors were malignant or metastasized or recurred.
The difficulty lies in where it lies. The tumor lies between the branches of the carotid artery and can cover them, and cranial nerves pass nearby, which depend on swallowing, voice and tongue movements. Therefore, both the tumor and its treatment can affect these structures.
Two more features: some chemodectomas are hereditary, and some secrete hormones. Therefore, the examination is not limited to the neck.
This is general information. The doctor will tell you what will suit you after the examination and examinations.
02 / SIGNSHow
How
chemodectoma presents.
Often a person simply feels a lump on the neck. In a meta-analysis of 104 studies (4,418 patients), this was the case in 75% of cases, and 85% of these nodules did not hurt.
Swallowing, nerves, head
Difficulty swallowing, damage to cranial nerves, or headache at the time of treatment were experienced by 3% of patients.
On both sides
In a pooled analysis of 9,291 patients, 13% had tumors on both sides of the neck, and 16% had multiple paragangliomas in different locations.
Attacks of sweating
In the pooled analysis, 12% of tumors were hormonally active. Excess hormones can cause headaches, sweating, palpitations and high blood pressure.
03 / REASONSWhy does it occur?
Why does it occur?
chemodectoma
The main known factor is heredity. Reviews also pay attention to the gender and age of patients.
SDH genes
Hereditary changes in succinate dehydrogenase (SDH) genes are considered the main genetic factors in the review. In the combined analysis, 36% of patients had them, 16% had a family history.
SDHD syndrome
In carriers of SDHD gene changes, paragangliomas mainly occur on the head and neck, and in almost 20%, they also occur in other places of the body.
Female sex
65% of the operated patients were women; reviews call female gender a risk factor.
age
In a meta-analysis of 4418 patients, the mean age of patients was 47 years.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Compaction itself usually does not require emergency care: in a meta-analysis of 4,418 patients, stroke as the first sign of a tumor occurred in 0.09%, microstroke — in 0.26%. But the tumor lies on the carotid artery, so signs of a stroke, especially after surgery, are a reason to call 103.
103 immediately if:
- the face was crooked, the corner of the mouth dropped on one side;
- cannot raise both arms, one is weak or numb;
- weakness or numbness of one half of the body;
- speech is unclear, it is difficult to find words;
- sudden deterioration or loss of vision in one or both eyes;
- these symptoms were present within the last 24 hours, even if they have already passed;
- it is very difficult to breathe - a person suffocates or cannot utter words;
- the neck swells quickly and it becomes difficult to breathe or swallow;
- bleeding from the wound does not stop;
- blood gushes from the wound, bright red.
See a doctor without delay if:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after the operation, swelling or pain grows near the wound, and it is not difficult to breathe and swallow. On the same day: after surgery, pus or blood is released from the wound, it is swollen and painful; high fever or chills. In the coming days: a lump on the side of the neck does not pass for 2 weeks, grows or is firm and does not move; repeated attacks of headache, sweating and palpitations. Planned: there are already paragangliomas or changes in SDH genes in the family - discuss the examination with the doctor.
05 / DIAGNOSTICSAs confirmed
As confirmed
chemodectoma
- Discussion and review
Since when there is a compaction, is it growing, are there attacks of sweating and palpitations, have there been paragangliomas in the family.
- MRI
The British consensus advises an MRI not only of the neck, but also of the head, chest, abdomen and pelvis — so as not to miss other tumors.
- Analyzing metanephrines
Blood or urine for hormone breakdown products show whether the tumor is hormonally active. The guideline advises to do this analysis at the very beginning, before any intervention - surgery, embolization or biopsy: if the tumor secretes hormones, preparation with drugs is required before the intervention to avoid complications.
- Genetic test
The guidelines recommend considering genetic testing for all patients, and testing for SDHx genes in paraganglioma.
- Class according to Shamblin
According to the images, it is estimated how tightly the tumor covers the carotid arteries: class I, II or III. The risk of the operation depends on this.
06 / TREATMENTHow we treat
How we treat
chemodectoma
There is no single way. The British consensus advises for most head and neck tumors to start with surveillance, and a meta-analysis by Shamblin class suggests that surgery is an acceptable option for class I and II tumors. The plan depends on the size and grade of the tumor, age, heredity, and whether it secretes hormones, and is made by a team of specialists.
01
Supervision
When the tumor is small and does not bother.
- Pictures in dynamics
- Regular MRIs show whether the tumor is growing. The consensus calls preservation of functions the main goal of treatment.
- What the surveillance shows
- In a follow-up cohort of 65 patients with 47 tumors that had repeat imaging, 66% were unchanged or reduced, 34% increased; subsequently, 9 tumors (18%) were operated on. Among those who did not have surgery, 86% never had symptoms.
- Restrictions
- Surveillance does not always prevent complications: they occurred in a cohort of 159 tumors and in 16% of those that did not grow.
02
Surgery
Removal of a tumor from under the carotid artery.
- Preparation
- If the tumor secretes hormones, drugs that block their effects are taken for several weeks before the operation.
- Embolization
- Before the operation, the tumor vessels are occluded through angiography. Reviews differ: in one meta-analysis (1,649 patients), it reduced the risk of vascular damage, and in another, the chances of stroke were higher (odds ratio 2.44), so the authors do not advise everyone to do it.
- Carotid artery
- In a review of 2,175 operated patients, the carotid artery had to be removed due to damage or sprouting in 12.5%, and immediately restored in 9.7%.
03
Risks of surgery
The higher, denser the tumor covers the arteries.
- Cranial nerves
- In a meta-analysis of 4418 patients, nerve damage in the first 30 days was 25.4%, after 30 days it remained in 11.15%. Because of this, swallowing, voice, movements of the tongue or face may suffer.
- A stroke
- In the same meta-analysis, 3.53% of patients had a stroke within 30 days, 4% with class III tumors; in another pooled analysis (9,291 patients) — 1%.
- By tumor class
- In a meta-analysis of 27 studies with low-quality evidence, nerve injury rates for grades I, II, and III were 3%, 17%, and 39%.
- Bleeding
- In the same meta-analysis, neck hematoma requiring reoperation was present in 5.24% of patients.
- Mortality
- In the same meta-analysis, 2.29% of patients died within 30 days after surgery, in a pooled analysis of 9,291 patients, 1%.
04
Irradiation
- Radiation therapy
- The British consensus considers it to be a mostly safe and effective treatment for growing tumors. In a review of different series of patients (this is not a comparative study), tumor control was achieved in 94.5% of 127 irradiated patients and 93.8% of 2175 operated patients; no new nerve disorders after irradiation were recorded, 22.2% had new persistent disorders after surgery.
- Follow-up after treatment
- After the operation, the European guideline advises observation for at least 10 years and an analysis for metanephrines every year; young people, carriers of hereditary changes and patients with paraganglioma - every year for life.
07 / AT THE VALIKHNOVSKYI INSTITUTE
What
What
we will help
At Dr. Valikhnovskyi's Institute of Surgery, soft tissue tumors and soft tissue tumors of the neck are examined in the "Soft Tissue Oncology" department. In the case of chemodectomy, the clinic is responsible for its part — consultation, assessment of images and plan; hormone analysis and genetic testing are conducted by an endocrinologist and geneticist, irradiation by a radiation therapist. Whether an operation is necessary and who will perform it is decided after examinations.
CLINIC SERVICE
Oncosurgery of soft tissues
Sarcomas and other soft tissue tumors — with preservation of the limb and restoration of tissues in the same operation.
View service
What we do for this condition
- Consultation and assessment of materials — the doctor reviews images, extracts and results of previous examinations and finds out the clinical situation.
- MRI — first a picture and a diagnosis, only then — a treatment plan.
- 3D modeling — a three-dimensional model from MRI and CT images shows how the tumor lies in relation to the carotid arteries, nerves and bones.
- Consilium — the surgeon, oncologist and radiation therapist together discuss the next steps and sequence of stages.
- Regular supervision — examinations and MRI of the site in dynamics.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How does the consultation work?
- Materials onlinePictures of the neck, tests and statements can be sent in advance - the doctor will assess the situation in advance.
- ConsultationReview, talk about symptoms and family, examination plan.
- ExaminationMRI, analysis for metanephrines, genetic test - part of it is done by a specialized doctor.
- Consilium and planSupervision, surgery or radiation - the team chooses with you.
- SupervisionRegular reviews, pictures and analyzes — for years.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is hemodectoma cancer?
Mostly no. In a pooled analysis of 9,291 patients, 6% of tumors were malignant or metastasized or recurred, in a review of malignant tumors, 7.3%. The examination advises to suspect a malignant tumor if it is more than 4 cm, class III, painful, is present on both sides, or is associated with SDH gene changes.
Is it necessary to operate?
No. The British consensus advises for most head and neck tumors to be surveillance first, for those that are growing, mostly radiation, and surgery has a limited role. For class I and II tumors, a meta-analysis considers surgery to be an acceptable option. Decisions are made individually.
How risky is the operation?
The tumor lies on the carotid artery next to the nerves. In a meta-analysis of 4,418 patients, 11.15% had persistent nerve damage after 30 days, 3.53% had a stroke within 30 days, and 2.29% died within 30 days. The denser the tumor covers the arteries, the higher the risk.
Why a genetic test?
Part of chemodectoma is hereditary: in the pooled analysis, 36% of patients had SDH gene changes. The result depends on how you will be monitored and whether relatives will be tested: in high-risk groups, the British consensus considers testing relatives mandatory.
What is embolization?
Obstruction of tumor vessels through angiography before surgery. Data on its benefits differ, so it is done by the decision of the team, not everyone.
Can the tumor come back?
Thus, the risk of new tumors persists for years, especially with hereditary forms. Therefore, the European guideline advises follow-up for at least 10 years, and for high-risk patients every year for life.
Can you just observe?
Yes, if the tumor is small and not bothersome: the British consensus calls surveillance the first choice for most head and neck tumors. In a follow-up cohort of 47 tumors with dynamic imaging, 66% did not enlarge. But surveillance requires regular MRIs and does not always prevent complications.
Sources
19 sources · consensus and guidelines, meta-analyses, cohorts, NHSshowCollapse
- British Skull Base Society Clinical Consensus Document on Management of Head and Neck ParagangliomasOtolaryngology–Head and Neck Surgery, 2020doi:10.1177/0194599820915490 ↗
- Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice GuidelineThe Journal of Clinical Endocrinology & Metabolism, 2014doi:10.1210/jc.2014-1498 ↗
- Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline SDHD pathogenic variantsThe Lancet Diabetes & Endocrinology, 2023doi:10.1016/S2213-8587(23)00038-4 ↗
- European Society of Endocrinology Clinical Practice Guideline for long-term follow-up of patients operated on for a phaeochromocytoma or a paragangliomaEuropean Journal of Endocrinology, 2016doi:10.1530/EJE-16-0033 ↗
- A Systematic Review and Meta-Analysis of the Presentation and Surgical Management of Patients With Carotid Body TumoursEuropean Journal of Vascular and Endovascular Surgery, 2019doi:10.1016/j.ejvs.2018.10.038 ↗
- Prevalence, characteristics, evaluation, and management of carotid body tumors: Systematic analysis based on available evidenceJournal of Vascular Surgery, 2024doi:10.1016/j.jvs.2024.03.443 ↗
- Role of Preoperative Embolization in Surgical Management of Carotid Body Tumors: A Systematic Review and Meta-AnalysisAngiology, 2025doi:10.1177/00033197231215240 ↗
- A meta-analysis on the surgical management of paraganglioma of the carotid body per Shamblin classClinical Otolaryngology, 2018doi:10.1111/coa.13116 ↗
- Carotid body paragangliomas: a systematic study on management with surgery and radiotherapyEuropean Archives of Oto-Rhino-Laryngology, 2014doi:10.1007/s00405-013-2384-5 ↗
- Malignant carotid body tumors: What we know, what we do, and what we need to achieve. A systematic review of the literatureHead & Neck, 2024doi:10.1002/hed.27624 ↗
- Head and neck paragangliomas: Recent advances in translational and clinical research and guidelines for patient careBest Practice & Research Clinical Endocrinology & Metabolism, 2024doi:10.1016/j.beem.2024.101951 ↗
- Feasibility of a wait-and-scan period as initial management strategy for head and neck paragangliomaHead & Neck, 2017doi:10.1002/hed.24871 ↗
- Outcomes of Carotid Body Tumor Management with Active SurveillanceAnnals of Otology, Rhinology & Laryngology, 2023doi:10.1177/00034894221105833 ↗
- Stroke: SymptomsNHS, 2024nhs.uk/conditions/stroke/symptoms ↗
- Complications of a carotid endarterectomyNHS, 2025nhs.uk/tests-and-treatments/carotid-endarterectomy/complications ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- Shortness of breathNHS, 2024nhs.uk/symptoms/shortness-of-breath ↗
- PhaeochromocytomaNHS, 2024nhs.uk/conditions/phaeochromocytoma ↗
The figures on the page are from these sources.
Found a seal
on the neck?
Send pictures of the neck and discharge. The doctor will evaluate whether it looks like a chemodectoma and tell what tests are needed next.