A rare case of schwannoma of the mandibular nerve extending to parapharyngeal space managed with a preauricular trans mandibular approach
DOI:
https://doi.org/10.18203/2349-2902.isj20230515Keywords:
Schwannoma, Transmandibular approach, Parotid tumorAbstract
Schwannoma also referred to as neurilemmoma or neurinomas arise from the Schwann cells of the autonomic nerves, peripheral nerves and cranial nerves except optic and olfactory nerves. Head and neck schwannomas account for 25 to 45% of schwannomas and the most common being vagal schwannomas and cervical sympathetic chain schwannomas. Schwannomas arising from the trigeminal nerve are rare and this case report consists of a schwannoma presenting as a left preauricular swelling involving the region of parotid extending from foramen ovale through the infratemporal fossa up to the parapharyngeal space. A combined preauricular trans mandibular approach enabled a complete excision of the tumor. Histopathological confirmation of a benign schwannoma was obtained and the patient is feeling well with minimal postoperative facial palsy with no trismus, occlusion abnormalities and no signs of recurrence on follow up.
References
Dosemane D, Kabekkodu S, Jaipuria B, Sreedharan S, Shenoy V. Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature. Braz J Otorhinolaryngol. 2021;S1808-8694(21)00109-9.
Samii M, Migliori MM, Tatagiba M, Babu M. Surgical treatment of trigeminal schwannomas. J Neurosurg. 1996;82:711e718.
Ginsberg L. Imaging of perineural tumor spread in head and neck cancer. In: Som PM, Curtin HD,editors. Head and neck imaging. St Louis: Mosby. 2003;865-85.
Schmalfuss IM, Tart RP, Mukherji S, Mancuso AA. Perineural tumor spread along the auriculotemporalnerve. AJNR Am J Neuroradiol. 2002;23(2):303-11.
Yousem DM, Grossman RI. Neuroradiology: the requisites. 3. Philadelphia: Mosby; 2010.
Som PM, Curtin HD. Parapharyngeal and masticator space lesions. In: Som PM, Curtin HD, editors. Head and neck imaging. 4. St Louis: Mosby. 2003;1954-2003.
Wei Y, Xiao J, Zou L. Masticator space: CT and MRI of secondary tumor spread. AJR Am J Roentgenol. 2007;189(2):488-97.
Liu HL, Yu SY, Li GK, Wei WI. Extracranial head and neck Schwannomas: a study of the nerve of origin. Eur Arch Otorhinolaryngol. 2011;268(9):1343-7.
Ansari I, Ansari A, Graison AA, Patil AJ, Joshi H. Head and Neck Schwannomas: A Surgical Challenge-A Series of 5 Cases. Case Rep Otolaryngol. 2018;2018:4074905.
Galli F, Flor N, Villa C, Franceschelli G, Pompili G, Felisati G et al. The masticator space. Value of computed tomography and magnetic resonance imaging in localisation and characterisation of lesions. Acta Otorhinolaryngol Ital. 2010;30(2):94-9.
Caldemeyer KS, Mathews VP, Righi PD, Smith RR. Imaging features and clinical significance of perineural spread or extension of head and neck tumors. Radiographics. 1998;18(1):97-110.
12.Sandikcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemeyer H: Spheno-orbital meningiomas: interdisciplinary surgical approach, resectability and long-term results. J Craniomaxillofac Surg. 2005;33:260e266.
Noguchi T, Sugiura Y, Okada N. A modified preauricular and transmandibular approach for surgical management of osteosarcoma of the mandibular condyle within the masticator space and infratemporal fossa: a case report. J Med Case Rep. 2019;13:58.
