Intraosseous Schwannoma Originating from Inferior Alveolar Nerve-A Case Report and Review of the Literatures

下齒槽神經原發許旺細胞瘤－病例報告與文獻回顧

陳依仁(I-Jen Chen) ； 羅文良(Wen-Liang Lo)

《臺灣口腔顎面外科學會雜誌》 31卷1期 (2020/03) Pp. 12-18

摘要

Schwannomas are the rare, slow growing benign neoplasm of peripheral nerves derived from Schwann cells, also known as neurilemmoma. Reports showed that 25% of the Schwannomas were originated in head and neck region, but rarely to be seen in the center of jaw. We present a case of mandibular intraosseous Schwannoma derived from the main trunk of inferior alveolar nerve in a 51-year-old man. Patient complained of tingling sensation of left lower lip and left lower swollen face for one month. On panoramic radiograph, cortical bone and mandibular canal expansion at left mandible ramus were noted. The pre-operative computed tomography of the face showed a radiolucent homogenic lesion at left mandible ramus measured 4 × 2.8 × 4.5 cm^3, which mimicked a cystic lesion. Enucleation was performed under general anesthesia followed by obturator fabrication. The whole lesion was enucleated and sent for biopsy. Inferior alveolar nerve neurotmesis was noted after tumor removal. The pathological finding showed spindle cells palisaded in Atoni A pattern and Atoni B pattern with positive S100 and neurofilament stain, which was compatible with Schwannoma. The left lower facial paranesthesia persisted without tumor recurrence after 2 years follow-up.

關鍵字

Intraosseous benign tumor ； Inferior alveolar nerve ； Mandible schwannoma

並列摘要

許旺細胞瘤為起源於神經鞘許旺細胞之良性腫瘤，又稱為神經鞘瘤。許旺細胞瘤為成長緩慢、獨立囊化之罕見腫瘤。約有百分之二十五的許旺細胞瘤起源自頭頸部，其中以源自聽神經居多；罕見於上下顎骨。本病例報告為一名下齒槽神經許旺細胞瘤之五十一歲男性患者，伴隨有持續一個月之左顏面、下顎骨腫脹及左下唇、舌及齒齦感覺異常。環口X光片檢查，呈現左下顎骨枝皮質骨擴張及下齒槽神經管擴大；臉部電腦斷層檢查，發現一4×2.8×4.5立方公分似良性囊腫之均質性放射線透射病灶。後於全身麻醉下進行病灶剜除及後續閉孔器之製作，並將移除之病灶送予病理檢驗。術中於腫瘤剜除後發現下齒槽神經斷裂。病理切片報告發現呈現高密度細胞型（安東尼式A型）及低密度細胞型（安東尼式B型）排列之梭狀細胞，特殊染色S100指標呈現陽性，確診為許旺細胞瘤。經兩年追蹤後病人仍伴隨有左下唇、舌及齒齦感覺異常；無腫瘤復發之情形。

並列關鍵字

骨内良性腫瘤 ； 下齒槽神經 ； 下顎骨許旺細胞瘤