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Surgical Management of Mandibular Intraosseous Schwannomas
Anthony DeLeonibus, B.S.; Bahar Bassiri Gharb, M.D., PhD.; Francis Papay, M.D.; James E. Zins, M.D.; Antonio Rampazzo, M.D. PhD.
Cleveland Clinic Foundation
2017-02-19
Presenter: Anthony DeLeonibus
Affidavit:
This is the medical student's, Anthony DeLeonibus' original work and he was involved in all steps of this study.
Director Name: Bahar Bassiri Gharb
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Mandibular intraosseous schwannomas are rare peripheral nerve sheath tumors that grow from the proximal branches or main trunk of the inferior alveolar nerve. The purpose of this study was to assess how the literature approaches mandibular schwannoma resections and compare our experience with the Sagittal Split Ramus Osteotomy as a surgical option.
Methods: Using Pubmed/Medline, a systematic review of the English literature was conducted from 1945 to 2016.
Results: There were forty-nine identified cases of intraosseous schwannomas in the mandible. The tumors most commonly appeared in the posterior mandible (n = 30, 61.2%). There were 28 cases in which the tumor directly involved the inferior alveolar nerve (57.1%). The most commonly performed procedures included enucleation through a mucoperiosteal flap and a bone window (73%), curettage (10%), segmental mandibulectomy (10%) and Sagittal Split Ramus Osteotomy (6%). The recurrence rate was 6%: all 3 recurrent cases occurred in the posterior area. We report a 72 year-old female with a inferior alveolar nerve schwannoma, which was removed through a sagittal split of the mandible, although there was a bony defect of the external cortex after biopsy of the lesion. The resected nerve was reconstructed with a sural nerve graft.
Conclusion: Since Schwannomas are slow growing and encapsulated tumors, surgical resection appears the best treatment with ideal functional outcomes and reduced recurrence rate even with a minimally invasive technique. Sagittal Split Ramus Osteotomy and segmental mandibulectomy are primarily performed for posterior or large tumors to facilitate radical resection or increase exposure and reconstruction.
