Case Report: Schwannoma of the Hypoglossal Nerve in a 48-Year-Old Female Patient

Introduction Schwannomas are benign tumors originating from Schwann cells of peripheral nerves. 25-45  %  of all schwannomas manifest in the head and neck area, most commonly as vestibular schwannoma. Only about 5 %  of all schwannomas in the head and neck area occur on the XII cranial nerve. Preoperative diagnosis is difficult despite MRI and CT. Anatomic localization is very similar to carotid paraganglioma or a branchial cyst. To completely remove the schwannoma, the nerve often hast to be severed. This case report shows the consequences of unilateral hypoglossal resection due to a schwannoma.

Case Report A 48-year old female patient presented with a painless tumor on her right neck. B-mode ultrasound revealed a 16x20mm, sharply defined mass in level IIa. MRI examination showed a homogeneous,hyperintense tumor in the carotid bifurcation. The tumor was completely removed via submandibular incision, whereby the hypoglossal nerve was severed. After operation there was a barely visible deviation of the tongue to the right and a slight restriction of tongue mobility. The histopathological findings confirmed a regressive schwannoma

Conclusion Although schwannomas of the hypoglossal nerve are rare and often become apparent during surgery, for tumors in Level IIa the hypoglossal schwannoma should be considered as a differential diagnosis. The postoperative course of this patient without relevant impairment to health makes it clear that loss of the hypoglossal nerve in order to completely resect the schwannoma makes sense in some cases.

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Publication History

Article published online:
13 May 2021