Surgical Approaches for Tongue Base Schwannoma

Abstract

Schwannomas (neurilemmomas) are benign nerve sheath tumor originating from Schwann cells. They are well circumscribed and rarely infiltrate and metastasize. Schwannomas of the head and neck commonly occur in the tongue followed by the palate, floor of mouth, buccal mucosa, and mandible. Tongue base schwannomas could extend to the pharyngeal cavity or the floor of the mouse, and it is difficult to differentiate between tumors of the lingual, hypoglossal, and glossopharyngeal nerves.Surgical treatment of tongue base schwannomas is difficult because of limited operative exposure. Although mandibulotomy with lip splitting could obtain good exposure, surgeons might strike a balance between exposure obtaining and morbidity following because there are intricate neurovascular anatomical relationships in this region, and mandibulotomy with lip splitting would cause significant morbidity. Surgical approach options are important for tongue base schwannoma removal. From March 2008 to March 2010, 8 patients were clinically and pathologically diagnosed with tongue base schwannomas in our department, and all underwent surgical treatment. In our experience, transoral approach was used for tongue base schwannomas extending to the floor of the mouse and suprahyroid pharyngotomy approach for those extending to the pharyngeal cavity. Follow-up was made until now. One patient who experienced transoral excision still experienced numbness in the region of the lateral tongue tip, and the other 7 patients had no postoperative long-term complications.