Neurilemmoma of the oral cavity Report of two cases and literature review
Maria PAPADAKI, Doxa MANGOUDI, Maria LAZARIDOU, Eleni BOURLIDOU
Oral and Maxillofacial Surgery Clinic, “G. Papanikolaou” General Hospital. Thessaloniki, Greece (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2015) 2, 49-56
SUMMARY: Neurilemmoma is a benign tumor originat- ing from Schwann cells of the myelin sheath that covers peripheral nerves. Twenty five to 48% of the neurilemmomas are located at the head and neck area. About 20-58% of those are located intraorally, most frequently involving the tongue and the cheek. Neurilemmomas should be included in the differential diagnosis of intra-oral tumors with healthy overlying mucosa. Magnetic resonance tomography is helpful in the preoperative diagnosis and can show the attachment of the neurilemmoma to the nerve from which it derived. Definite di- agnosis is established with biopsy. Local excision and re- construction of the defect is the treatment of choice. In this paper, we present two cases of oral neurilemmoma, one deriving from the hypoglossal nerve that was re- moved through a submandibular approach and one located on the palate that was excised and the defect reconstructed with buccal fat pad. A literature review is performed regarding pathogenesis, diagnosis and treatment of Neurilemmoma.
KEY WORDS: Neurilemmoma, swannoma, nerve, neo- plasm, myelin, intraoral location.
REFERENCES
Amir R, Altman KW, Zaheer S: Neurilemmoma of the hard palate.
J Oral Maxillofac Surg 60: 1069-1071, 2002
Castonguay, A., Levesque S, Robitalle R: Glial cells as active partners in synaptic functions. Progress in Brain Research 132:227-39, 2001 Cherrick HM, Eversole LR: Benign neural sheath neoplasm of the oral cavity. Report of thirty-seven cases. Oral Surg Oral Med Oral
Pathol 32:900-909, 1971
Chrysomali E, Papanicolaou SI, Dekker NP, Regezi JA: Benign neural tumors of the oral cavity: a comparative immunohistochemical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84: 381-390, 1997
Colin W: Trigeminal intraoral schwannomas. Compendium 11: 674- 677, 1990.
Eccleston PA, Mirsky R, Jessen KR: Spontaneous immortalisation of Schwann cells in culture: short-term cultured Schwann cells se- crete growth inhibitory activity. Development 112:33-42, 1991
Geist JR, Gander DL, Stefanac SJ: Oral manifestations of neurofibro- matosis types I and II. Oral Surg Oral Med Oral Pathol 73: 376- 382, 1992
Gutmann DH, Aylsworth A, Carey JC: The diagnostic evaluation and multidisciplinary management of neurofibromatosis 1 and neurofi- bromatosis 2. JAMA 278: 51-57, 1997
Hafer-Macko CE, Sheikh KA, Li CY, Ho TW, Cornblath DR, McKhann GM, Asbury AK, Griffin JW: Immune attack on the Schwann cell surface in acute inflammatory demyelinating polyneuropathy. Ann Neurol 39:625-635, 1996
Humber CC, Copete MA, Hohn FI. Ancient schwannoma of upper lip: case report with distinct histologic features and review of the lit- erature. J Oral Maxillofac Surg. 69:118-122, 2011
Iatrou I, Fotopoulos D, Theologie-Lygidakis N, Michail A: Preauricular fa- cial nerve neirilemmoma in a pediatric patient. A case report. Hel- lenic Archives of Oral and Maxillofacial Surgery 2, 113-120, 2011
Jones JA, McWilliam LJ: Intraoral neurilemmoma (schwannoma): an un- usual palatal swelling. Oral Surg Oral Med Oral Pathol 63:351- 353, 1987
Jordan RC, Regezi JA. Oral spindle cell neoplasms: a review of 307 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95: 717-724, 2003
Kimura H, Fischer WH, Schubert D: Structure, expression, and function of a schwannoma-derived growth factor. Nature 348: 257-260, 1990
King AD, Ahuja AT, King W, Metreweli C: Sonography of peripheral nerve tumor of the neck. Am J Roentgenol 169: 1695–1698, 1997 Kun, Q.I. Dao-Yi and Z. Kui-Hua: A comparison between the clinical behavior of neurilemomas in the neck and oral and maxillofacial
region. J Oral Maxillofac Surg 51: 769–771, 1993
Mahmood L, Demian N, Weinstock YE, Weissferdt A.Mandibular nerve schwannoma resection using sagittal split ramus osteotomy. J Oral Maxillofac Surg. 71:1861-1872, 2013
Muir D, Varon S, Manthorpe M: Schwann cell proliferation in vitro is under negative autocrine control. J Cell Biol 111: 2663-2671, 1990 Nakasato T, Katoh K, Ehara S, Tamakawa Y, Hoshino M, Izumizawa M,
Sakamaki K, Fukuta Y, Kudoh K: Intraosseous neurilemmoma of the mandible. AJNR Am J Neuroradiol 21:1945-1947, 2000
Rallis G, Mourouzis K, Maltezos C, Stathopoulos P. Hemiatrophy of the tongue caused by an extensive vagus nerve schwannoma mas- querading as a carotid chemodectoma. J Maxillofac Oral Surg. 14(Suppl 1):366-9, 2015
Sainz J, Huynh DP, Figueroa K: Mutations of the neurofibromatosis type 2 gene and lack of the gene product in vestibular schwan- nomas. Hum Mol Genet 3: 885-891, 1994
Scheithauer BW, Woodruff JM, Erlandson RA: Tumors of the periph- eral nervous system. In: Armed Forces Institute of Pathology: Atlas of Tumor Pathology. Rosai J, Sobin LH 1999, pp. 105-176
Tos M, Stangerup SE, Caye-Thomasen P, Tos T, Thomsen J: What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 130(2):216-220, 2004
Williams HK, Cannell H, Silvester K, Williams DM: Neurilemmoma of the head and neck. Br J Oral Maxillofac Surg 31:32-35, 1993
Wright BA, Jackson D: Neural tumors of the oral cavity. A review of the spectrum of benign and malignant oral tumors of the oral cav- ity and jaws. Oral Surg Oral Med Oral Pathol 49: 509-522, 1980
Yang SW, Lin CY: Schwannoma of the upper lip: case report and lit- erature review. Am J Otolaryngol 24:351-354, 2003
Young H, Hyman S, North K: Neurofibromatosis 1: clinical review and exceptions to the rules. J Child Neurol 17:613-621, 2002
Yamazaki H, Kaneko A, Ota Y, Tsukinoki K: Schwannoma of the mental nerve: usefulness of preoperative imaging: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:122-126, 2004
Zachariades N, Mezitis M, Vairaktaris E, Triantafyllou D, Skoura-Kafous- sia C, Konsolaki-Agouridaki E, Hadjiolou E, Papavassiliou D:
Benign neurogenic tumors of the oral cavity. Int J Oral Maxillofac Surg 16: 70-76, 1987
Oral and Maxillofacial Surgery Clinic, “G. Papanikolaou” General Hospital. Thessaloniki, Greece (Head: Professor K. Antoniadis)
Hellenic Archives of Oral & Maxillofacial Surgery (2015) 2, 49-56
SUMMARY: Neurilemmoma is a benign tumor originat- ing from Schwann cells of the myelin sheath that covers peripheral nerves. Twenty five to 48% of the neurilemmomas are located at the head and neck area. About 20-58% of those are located intraorally, most frequently involving the tongue and the cheek. Neurilemmomas should be included in the differential diagnosis of intra-oral tumors with healthy overlying mucosa. Magnetic resonance tomography is helpful in the preoperative diagnosis and can show the attachment of the neurilemmoma to the nerve from which it derived. Definite di- agnosis is established with biopsy. Local excision and re- construction of the defect is the treatment of choice. In this paper, we present two cases of oral neurilemmoma, one deriving from the hypoglossal nerve that was re- moved through a submandibular approach and one located on the palate that was excised and the defect reconstructed with buccal fat pad. A literature review is performed regarding pathogenesis, diagnosis and treatment of Neurilemmoma.
KEY WORDS: Neurilemmoma, swannoma, nerve, neo- plasm, myelin, intraoral location.
REFERENCES
Amir R, Altman KW, Zaheer S: Neurilemmoma of the hard palate.
J Oral Maxillofac Surg 60: 1069-1071, 2002
Castonguay, A., Levesque S, Robitalle R: Glial cells as active partners in synaptic functions. Progress in Brain Research 132:227-39, 2001 Cherrick HM, Eversole LR: Benign neural sheath neoplasm of the oral cavity. Report of thirty-seven cases. Oral Surg Oral Med Oral
Pathol 32:900-909, 1971
Chrysomali E, Papanicolaou SI, Dekker NP, Regezi JA: Benign neural tumors of the oral cavity: a comparative immunohistochemical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84: 381-390, 1997
Colin W: Trigeminal intraoral schwannomas. Compendium 11: 674- 677, 1990.
Eccleston PA, Mirsky R, Jessen KR: Spontaneous immortalisation of Schwann cells in culture: short-term cultured Schwann cells se- crete growth inhibitory activity. Development 112:33-42, 1991
Geist JR, Gander DL, Stefanac SJ: Oral manifestations of neurofibro- matosis types I and II. Oral Surg Oral Med Oral Pathol 73: 376- 382, 1992
Gutmann DH, Aylsworth A, Carey JC: The diagnostic evaluation and multidisciplinary management of neurofibromatosis 1 and neurofi- bromatosis 2. JAMA 278: 51-57, 1997
Hafer-Macko CE, Sheikh KA, Li CY, Ho TW, Cornblath DR, McKhann GM, Asbury AK, Griffin JW: Immune attack on the Schwann cell surface in acute inflammatory demyelinating polyneuropathy. Ann Neurol 39:625-635, 1996
Humber CC, Copete MA, Hohn FI. Ancient schwannoma of upper lip: case report with distinct histologic features and review of the lit- erature. J Oral Maxillofac Surg. 69:118-122, 2011
Iatrou I, Fotopoulos D, Theologie-Lygidakis N, Michail A: Preauricular fa- cial nerve neirilemmoma in a pediatric patient. A case report. Hel- lenic Archives of Oral and Maxillofacial Surgery 2, 113-120, 2011
Jones JA, McWilliam LJ: Intraoral neurilemmoma (schwannoma): an un- usual palatal swelling. Oral Surg Oral Med Oral Pathol 63:351- 353, 1987
Jordan RC, Regezi JA. Oral spindle cell neoplasms: a review of 307 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95: 717-724, 2003
Kimura H, Fischer WH, Schubert D: Structure, expression, and function of a schwannoma-derived growth factor. Nature 348: 257-260, 1990
King AD, Ahuja AT, King W, Metreweli C: Sonography of peripheral nerve tumor of the neck. Am J Roentgenol 169: 1695–1698, 1997 Kun, Q.I. Dao-Yi and Z. Kui-Hua: A comparison between the clinical behavior of neurilemomas in the neck and oral and maxillofacial
region. J Oral Maxillofac Surg 51: 769–771, 1993
Mahmood L, Demian N, Weinstock YE, Weissferdt A.Mandibular nerve schwannoma resection using sagittal split ramus osteotomy. J Oral Maxillofac Surg. 71:1861-1872, 2013
Muir D, Varon S, Manthorpe M: Schwann cell proliferation in vitro is under negative autocrine control. J Cell Biol 111: 2663-2671, 1990 Nakasato T, Katoh K, Ehara S, Tamakawa Y, Hoshino M, Izumizawa M,
Sakamaki K, Fukuta Y, Kudoh K: Intraosseous neurilemmoma of the mandible. AJNR Am J Neuroradiol 21:1945-1947, 2000
Rallis G, Mourouzis K, Maltezos C, Stathopoulos P. Hemiatrophy of the tongue caused by an extensive vagus nerve schwannoma mas- querading as a carotid chemodectoma. J Maxillofac Oral Surg. 14(Suppl 1):366-9, 2015
Sainz J, Huynh DP, Figueroa K: Mutations of the neurofibromatosis type 2 gene and lack of the gene product in vestibular schwan- nomas. Hum Mol Genet 3: 885-891, 1994
Scheithauer BW, Woodruff JM, Erlandson RA: Tumors of the periph- eral nervous system. In: Armed Forces Institute of Pathology: Atlas of Tumor Pathology. Rosai J, Sobin LH 1999, pp. 105-176
Tos M, Stangerup SE, Caye-Thomasen P, Tos T, Thomsen J: What is the real incidence of vestibular schwannoma? Arch Otolaryngol Head Neck Surg 130(2):216-220, 2004
Williams HK, Cannell H, Silvester K, Williams DM: Neurilemmoma of the head and neck. Br J Oral Maxillofac Surg 31:32-35, 1993
Wright BA, Jackson D: Neural tumors of the oral cavity. A review of the spectrum of benign and malignant oral tumors of the oral cav- ity and jaws. Oral Surg Oral Med Oral Pathol 49: 509-522, 1980
Yang SW, Lin CY: Schwannoma of the upper lip: case report and lit- erature review. Am J Otolaryngol 24:351-354, 2003
Young H, Hyman S, North K: Neurofibromatosis 1: clinical review and exceptions to the rules. J Child Neurol 17:613-621, 2002
Yamazaki H, Kaneko A, Ota Y, Tsukinoki K: Schwannoma of the mental nerve: usefulness of preoperative imaging: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:122-126, 2004
Zachariades N, Mezitis M, Vairaktaris E, Triantafyllou D, Skoura-Kafous- sia C, Konsolaki-Agouridaki E, Hadjiolou E, Papavassiliou D:
Benign neurogenic tumors of the oral cavity. Int J Oral Maxillofac Surg 16: 70-76, 1987
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