Schwannome du nerf mandibulaire

Abstract

Malignant schwannoma is a rare peripheral nerve-sheath tumour. It represents 5 to 10% of soft tissue sarcomas according to Grobmyer et al. in 2008 [1]. The cervico-facial localisation is very rare, representing only 1% of mandibular tumours. We report a case of a 64-year-old male patient who developed a malignant schwannoma at the level of the inferior dental nerve. In spite of the initial complete resection of this lesion, the patient has developed a recurrence with a proximal extension. For this reason, he has been transferred to our centre, where we conducted a wide surgical resection, associated with a homolateral neck dissection and postoperative external radiotherapy. After 1 year of follow-up, we did not observe any recurrence. Malignant schwannoma is a rare lesion which develops at the level of the peripheral nervous system sheath. Its cervico-facial localisation is very scarce, and its diagnosis is difficult to establish in spite of a complete radiological examination; definitive diagnosis depends on the histological examination. There is no strict consensus for the management of these lesions, however a wide surgical excision and neck dissection associated with or without postoperative radiotherapy and/or chemotherapy are the gold standard methods of treatment. The prognosis is usually bad due to the high risk of recurrence, sometimes difficult to diagnose.