Extracranial non-vestibular head and neck schwannomas: a case series with the review of literature

• Published in: Brazilian journal of otorhinolaryngology Vol. 88; no. Suppl 4; pp. S9 - S17
• Main Authors: Dosemane, Deviprasad, Kabekkodu, Sushmitha, Jaipuria, Bhagyashree, Sreedharan, Suja, Shenoy, Vijendra
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier Editora Ltda 01-11-2022; Elsevier; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial
• Subjects: Diagnosis, Differential; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - surgery; Histopathology; Humans; Myelin sheath; Neck - pathology; Neurilemmoma; Neurilemmoma - diagnosis; Neurilemmoma - pathology; Neurilemmoma - surgery; Original; OTORHINOLARYNGOLOGY; Schwannoma; Vagus Nerve; Histopathology; Neurilemmoma; Vagus nerve; Myelin sheath; Schwannoma
• ISSN: 1808-8694; 1808-8686; 1808-8686
• DOI: 10.1016/j.bjorl.2021.05.013

•Head and neck schwannomas commonly present as a painless swelling in the neck, mostly in middle-aged females.•Contrast computed tomography and magnetic resonance images can guide the diagnosis as well as surgery.•Fine needle aspiration cytology with cellular smears is a cost-effective diagnostic tool for superficial lesions.•Complete enucleation with preservation of nerve of origin is the preferred treatment modality, with negligible recurrence.•Postoperative nerve palsy may be seen if the nerve of origin is not adequately identified or inaccessible.
Schwannomas are tumous that arise from Schwann cells. Schwannoma is one of the differential diagnosis for lateral neck swelling.
In this study, we aim to describe the incidence, presenting clinical features and management of extracranial, non-vestibular schwannomas of head and neck region, along with the review of the literature.
Patients treated at our tertiary care hospital for head and neck schwannomas for the past 15 years were included in the study. A review of literature on the extracranial head and neck schwannoma was also done.
Twenty-five cases were assessed in this study. Nineteen cases presented as a neck swelling during the initial evaluation. Vagus nerve was the most common nerve of origin, followed by the cervical sympathetic plexus. A rare presentation arising from brachial plexus C5 nerve root was also encountered. A few rare cases of schwannomas arose from the nasal cavity, paranasal sinuses, and oral cavity. Surgical excision was done in all the cases with histopathology suggestive of schwannoma. The nerve of origin of the tumor was identified in nineteen patients. Among them, 11 (58%) were from the vagus nerve, 7 (37%) from the cervical sympathetic chain, and 1 (4%) from the brachial plexus C5 nerve root.
A long-standing unilateral neck mass is the most common presenting complaint in head and neck schwannoma. The diagnosis is mainly based on clinical features and investigations such as imaging. The mainstay of treatment is complete surgical excision. The diagnosis is confirmed on the histopathological study after excision of the lesion. Due to the proximity of the tumor with the involved nerve, palsy may occur. Hence, an accurate preoperative diagnosis of schwannoma is essential.