Intraoral schwannoma in retromolar region

Trans-oral, Carbon Dioxide-Assisted Excision of an Unusual Schwannoma of the Tongue Base: Case Report and Review of the Literature

Introduction  Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO ₂ ) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds.

Objective  We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO ₂ -assisted excision. We also provide a review of the available literature, in English language, on humans.

Data synthesis  The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma . Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases.

Conclusion  We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO ₂ laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.

Surgical management of extracranial nerve sheath tumours in a tertiary care center

Objective

Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures.

Methods

It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital. The retrospective clinical data, diagnostic procedures, surgical approaches and their complications are analyzed after 12 months of surgery.

Results

Total 13 patients, 7 were females and 6 were males. Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients). Transcervical excision of the tumour was performed in 7 patients. Six needed combined surgical approach for the excision of the tumours. Neurovascular injury was detected in 3 patients, and one patient had recurrent disease during the follow-up period.

Conclusions

Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure. Although the transcervical approach is commonly practiced for the majority of the tumours, combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.

Comprehensive Analyses of Intraoral Benign and Malignant Nerve Sheath Tumors: The Rare Disease Entities Revisited

INTRODUCTION

Intraoral benign and malignant nerve sheath tumors (BNST and MNST) are rare tumors with non-specific clinical presentations and represent diagnostic and therapeutic challenges. Current knowledge regarding their demographic, clinicopathological features and treatments remains fragmented.

MATERIALS AND METHODS

The original data about patients diagnosed as intraoral BNST and MNST were retrieved from our disease registry (2005-2017). Comprehensive reviews of English and Chinese literature were performed to collect and analyze the epidemiological, clinicopathological data and treatment outcomes about those published cases.

RESULTS

Thirty-four intraoral BNSTs were found at our institution in the past 13 years. Literature reviews identified 354 intraoral BNSTs in 223 articles and 60 intraoral MNSTs in 50 articles. Most intraoral BNSTs and MNSTs were presented in the second to fifth decade of life. Males outnumbered females in MNSTs, while BNSTs displayed a slight female preponderance. The common sites for intraoral BNSTs were parapharyngeal space followed by tongue, whereas mandible was the most common site for MNSTs. Most intraoral BNSTs were presented as slow-growing, painless mass or swelling, while MNSTs usually appeared as painful and invasive mass with discomfort. Surgical excision was preferred for intraoral BNSTs with excellent prognosis. Complete resection was indicated for intraoral MNST with dismal prognosis as evidenced by much recurrence, metastasis, and death.

CONCLUSION

Intraoral BNST and MNST are rare diseases which should not be ignored when intraoral painless or painful mass/swelling is found. Surgical excision is indicated for intraoral BNST with favorable outcomes. However, further investigations are warranted to optimize the treatment for intraoral MNST to improve its prognosis.

Tongue base schwannoma: differential diagnosis and imaging features with a case presentation

Schwannomas are slow growing, encapsulated neoplasms that arise from the nerve sheath. A vast majority of these benign neoplasms occur in the head and neck region, most commonly involving the 8th cranial nerve. Schwannomas arising from the base of tongue are very rare and, thus, can easily escape the list of differential diagnosis for a posterior tongue mass. A systematic approach is recommended for diagnosis of a posterior tongue mass, with neoplastic, infectious, and congenital categories. We report a case of a 24-year-old female, who presented with pressure sensation in the throat. On imaging, she was found to have a mass in the right posterior tongue with follow-up biopsy results yielding a schwannoma. Characteristic imaging features for various possible etiologies of a posterior tongue mass are also discussed.

Hypofractionated stereotactic radiotherapy for dumbbell-shaped hypoglossal schwannomas: Two cases of long-term follow-up and a review of the literature

Cases of hypoglossal schwannoma are extremely rare. Historically, microsurgical resection has been the standard treatment, but it may not always be feasible; thus, it is crucial to investigate alternative treatments. We herein present the cases of two patients, both of whom presented with tongue deviation and hemiatrophy, accompanied by headaches. Magnetic resonance imaging revealed a dumbbell-shaped tumor originating from the hypoglossal nerve that was adjacent to the cranial base in each patient. Hypofractionated stereotactic radiotherapy was used to treat the tumors, with a total dose of 30 Gy in 3-Gy fractions delivered to the planning target volume. Several months later, the tumors had significantly decreased in size and the symptoms of the two patients had gradually improved.

Extracranial neurogenic tumors of the head and neck

Introduction

Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis.

Objective

To report the experience of a tertiary care department.

Methods

Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study.

Results

The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5 cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin.

Conclusions

Extracranial neurogenic tumors presented with a mean size of 5.5 cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.