Schwannoma of the Floor of the mouthProf. Arens
18 April 2018 (online)
A schwannoma is a benign, slow growing tumor of the peripheral nervous system that originates from Schwann cells. 25%-45% of all schwannomas arise in the head and neck area, of which 1%-12% are located intraorally. This case report provides an overview of the clinical symptoms, diagnosis and therapy.
A 23-year-old male patient presented with a tumor located in the floor of the mouth and in the tongue. The tumor came first several years ago. Hypersalivation and a restricted articulation were reported. The patient denied the abuse of nicotine or alcohol and had no history of relevant preexisting diseases. The examination revealed a hard, indolent tumor covered by regular mucosa. The movement of the tongue was restricted and demonstrated a deviation to the left side. MRI showed a sublingual cystic mass of 5 × 5x4 cm3. Sonography revealed a tumor with echo-free and echo-rich areas and a distal sound amplification. In addition, the sonography showed a parietal perfusion of the tumor and contact to both the sublingual and submandibular glands. Botox was injected preoperatively into the big salivary glands. The tumor was excised using a transoral approach followed by plastic reconstruction of the floor of the mouth. Due to the large size of the tumor the patient remained intubated overnight. The final histopathological examination showed a schwannoma with an Antoni A pattern, and immunohistochemistry displayed a positive staining for S-100 protein.
The schwannoma is a differential diagnosis of a benign neoplasm. The therapy of choice is the complete excision via transoral approach. Infrequent other approaches include cervical accesses via submandibular and transhyoid approaches. In case of complete resection, patients will remain free of recurrence.