Schwannomas of the head and neck are slow-growing tumors, usually presenting as asymptomatic masses. Most of the extracranial schwannomas arise in the parapharyngeal space and are usually of vagal origin. Meanwhile, Schwannoma of the cervical sympathetic chain (SCSC) is a rare entity.

The vagus nerve courses between the IJV and ICA along the entirety carotid sheath; hence schwannomas of vagal origin tend to separate these vessels. The cervical sympathetic chain is found posteromedial to ICA and IJV; therefore schwannomas of the cervical sympathetic chain will not separate these vessels. SCSC rarely can splay the CCA bifurcation but without encasing ICA and ECA. Teaching point, in this case, is that schwannoma of the cervical sympathetic chain have a propensity to displace ICA and IJV in the same direction, while vagal schwannoma displaces them in opposite direction.