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Schwannoma of the Mylohyoid Nerve: A Case Report and Review of Literature of Sublingual Schwannomas

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Abstract

Introduction

Schwannomas are benign neurogenic tumors arising from neural sheaths and rarely develop in the sublingual space. We report the case of an ancient sublingual schwannoma in an asymptomatic 12-year-old patient. Furthermore, we propose a review of the literature on non-vestibular schwannomas of the sublingual region.

Materials and Results

We performed a complete excision of the lesion through a submandibular transcervical approach, sparing the left sublingual and submandibular glands, lingual nerve, and hypoglossal nerve. There was no need to perform a sural nerve graft to restore nerve function. The nerve of origin was identified intraoperatively as the mylohyoid nerve and was sacrificed during the en-block removal of the lesion. As of today, there are still multiple issues in the diagnosis and management of head and neck non-vestibular schwannomas. Preoperative evaluation through fine-needle aspiration cytology has an accuracy of only 20%. Identification of the nerve of origin is complex but critical to preserve nerve function after treatment.

Conclusion

An accurate preoperative evaluation allows to make an informed decision whether to undergo surveillance or surgery, with potential nerve grafting after removal of the lesion. Definitive diagnosis is often possible only after surgery, with clinical observation and histopathological examination of the surgical specimen.

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Acknowledgements

The authors acknowledge Dr Maurizio Boggio for the pathological analysis.

Funding

This research received no external funding.

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Author notes

  1. Alessia Pennacchi and Filippo Marchi share the first authorship since equally contributed to this manuscript.

Authors and Affiliations

  1. Department of Otolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Alessia Pennacchi, Filippo Marchi & Giorgio Peretti

  2. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132, Genoa, Italy

    Alessia Pennacchi, Filippo Marchi & Giorgio Peretti

  3. Department of Otorhinolaryngology, Ospedale San Paolo, 17100, Savona, Italy

    Giovanni Delù

  4. Department of Internal Medicine (DIMI), University of Genova, Viale Benedetto XV 6, Genoa, Italy

    Simone Caprioli

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  1. Alessia Pennacchi
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  2. Filippo Marchi
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  3. Giovanni Delù
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Contributions

Study concepts contributed by FM and GP. Study design contributed by FM and AP. Data acquisition contributed by FM, AP, SC. Quality control of data and data analysis and interpretation contributed by FM, GP, and GD. Manuscript preparation contributed by FM, AP, and SC. Manuscript editing contributed by FM. Manuscript review contributed by GP. All the authors have made a significant contribution to this manuscript, have seen and approved the final manuscript, and have agreed to its submission.

Corresponding author

Correspondence to Alessia Pennacchi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Regional Ethics Committee (Registry number CER Liguria: 133/2021—DB id 11296). The research was conducted ethically, with all study procedures being performed in accordance with the requirements of the World Medical Association’s Declaration of Helsinki. Written informed consent was obtained from each participant/patient for study participation and data publication.

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Pennacchi, A., Marchi, F., Delù, G. et al. Schwannoma of the Mylohyoid Nerve: A Case Report and Review of Literature of Sublingual Schwannomas. J. Maxillofac. Oral Surg. (2023). https://doi.org/10.1007/s12663-023-01867-x

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