Schwannoma arising from the sublingual glandular branch of the lingual nerve radiologically masquerading as sublingual gland tumor

Current Diagnostics and management of submandibular space schwannoma: a systematic review

BACKGROUND

Submandibular space schwannomas (SSS) are rare tumors originating from the neural sheath in the submandibular region with varied prognoses.

OBJECTIVE

The primary objective was to evaluate the current diagnostic and management outcomes of SSS.

MATERIAL AND METHODS

PubMed, Embase, Science Direct, and Web of Science were reviewed for articles from inception through January 2025. Fisher's test was used to calculate the difference in outcomes between extraglandular (EG) and intraglandular (IG) subtypes.

RESULTS

A total of 44 studies with 47 patients were included with a mean age (SD) of 42.8 (19.3) years. Hypoglossal nerve (43.3%) and lingual nerve (36.6%) were the primary nerve of origin for SSS, with significantly higher rates of hypoglossal nerve origin in EG-SSS than IG-SSS (p = .008). Sensitivity analysis of preoperative biopsy showed higher sensitivity rates with core biopsy compared to fine-needle aspiration cytology (FNAC) (85.7% vs. 38.7%) in SSS diagnosis. IG schwannomas are more likely to undergo submandibular gland excision (p = .002) than EG schwannoma.

CONCLUSION

Core biopsy demonstrated superior sensitivity compared to FNAC, establishing it as the preferred diagnostic tool. The hypoglossal nerve was the most identified nerve of origin.

SIGNIFICANCE

This review offers a comprehensive insight into the preoperative and perioperative management of SSS subtypes for surgeon decisions.

Lingual nerve revisited-A comprehensive review Part II: Surgery and radiology

The lingual nerve (LN) is a branch of the mandibular division of the fifth cranial nerve, the trigeminal nerve, arising in the infratemporal fossa. It provides sensory fibers to the mucous membranes of the floor of the mouth, the lingual gingiva, and the anterior two-thirds of the tongue. Although the LN should rarely be encountered during routine and basic oral surgical procedures in daily dental practice, its anatomical location occasionally poses the risk of iatrogenic injury. The purpose of this section is to consider this potential LN injury risk and to educate readers about the anatomy of this nerve and how to treat it.

Multiple Schwannomas Arising in the Midline Space Between the Bilateral Genioglossus Muscles and Left Submandibular Space

Schwannomas mostly occur as solitary tumors, and multiple schwannomas are very rare. Schwannomas in the submandibular space are extremely rare. Furthermore, schwannomas in the midline space between the bilateral genioglossus muscles are even rarer. We report multiple schwannomas arising in the midline space between the bilateral genioglossus muscles and left submandibular space. Because the common differential diagnosis of the midline deep sublingual lesions does not include schwannoma for the rarity, surgeons should consider schwannoma in the differential diagnosis.

Rare case of lingual nerve schwannoma of parapharyngeal space

Schwannoma of parapharyngeal space is an uncommon benign tumour of head and neck region. These are slow-growing and usually well-encapsulated masses arising from Schwann cells of cranial nerves. The majority of schwannoma in parapharyngeal space arise from vagus; however, cases have been reported with origin from other cranial nerves. Complete surgical excision is the treatment of choice. We recently experienced a case of schwannoma arising in parapharyngeal space of lingual nerve origin which was treated by transcervical excision.

A clinical study of submandibular schwannoma

OBJECTIVE

Schwannoma is a slowly growing benign neurogenic tumor that develops from the cells of the nerve sheath. The occurrence of schwannoma in the submandibular space is very rare.

MATERIALS AND METHODS

From January 2010 to March 2021, we reviewed all patients who had been operated on in the otolaryngology department over 11 years and found 61 patients diagnosed with schwannomas at the final biopsy after surgery. In these patients, only 3 submandibular schwannomas were identified, and their clinical characteristics were analyzed.

RESULTS

Three schwannomas (4.9%) developed in the submandibular space. The main symptoms were neck swelling followed by neck discomfort. All submandibular schwannomas were removed surgically with a transcervical approach under general anesthesia. Two patients, who were diagnosed preoperative submandibular tumors, were considered to have developed schwannomas from the lingual nerve, and 1 patient was considered to have developed a schwannoma from the hypoglossal nerve. There were no major surgical complications, including postoperative nerve damage.

CONCLUSIONS

Submandibular schwannomas are extremely rare, but they should be included in the differential diagnosis of submandibular tumors.