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European Journal of Scientific Research ISSN 1450-216X Vol.14 No.3 (2006), pp. 434-438 © EuroJournals Publishing, Inc. 2006 http://www.eurojournals.com/ejsr.htm Sublingual Schwannoma in a Nigerian African-a Case Report Rahman G.A Consultant General Surgeon, Dept of Surgery University of Ilorin Teaching Hospital Ilorin-Nigeria E-mail: garahman1@yahoo.com Alabi.B.S Consultant ENT/Head&Neck Surgeon, Dept of Otolaryngology University of Ilorin Teaching hospital P.O.Box 4210, Ilorin-Nigeria Email: alabibs@yahoo.com Afolabi.O.A Senior Registrar, ENT/Head&Neck Surgeon, Dept of Otolaryngology University of Ilorin Teaching hospital Ilorin-Nigeria Bramoh.K.T Consultant Radiologist, Dept of Radiodiagnosis University of Ilorin Teaching Hospital Ilorin- Nigeria Buhari.M.O Consultant Histopathologist, Dept of Morbid Anatomy&Histopathology University of Ilorin Teaching Hospital Ilorin-Nigeria Introduction Schwannoma is an encapsulated tumour derived from Schwann cells around the peripheral, cranial and autonomic nerves 7 . It generally develops from the sensory nerves, rarely from the motor nerves. One of the favoured sites is the head and neck area (25-45%) but occurs intracranially mostly 7 . The incidence of Schwannoma in the oral floor is extremely low. It occurs regardless of age or sex grows slowly and is usually painless. The tumour may arise at any age, some series have reported that it is common in adults in contrast to the neurofibroma, which tends to be commoner in young children. Most reports suggest that the majority of the tumours are present between the ages of 10 and 40years 9, 2, 5 . The aetiology is unknown, but it is postulated that the lesion arises by the proliferation of Schwann cells at one point inside the perineurium of the nerve. There have been approximately 146 Schwannomas reported from the oral soft tissues 2, 5 . Neurinomas of interest to otolaryngologists are usually solitary lesions, they appear encapsulated but may have invasive tendencies and may recur after removal 1 .
Sublingual Schwannoma in a Nigerian African-a Case Report 435 Sonography is the first line imaging modality in assessment of salivary glands. Due to their superficial position, the parotid, the submandibular, and the sublingual glands can be imaged with high- resolution transducers. Sonography enables the diagnosis of cysts or ranulae. Schwannoma appear as a wellcircumscribed, circular type mass with smooth margin on images. Tumours of salivary glands can be visualized with sensitivity but like other imaging techniques (MRI & CT-Scan) the specificity in assessment of the histology of a tumour is low in many diseases 6 .Schwannoma should be suspected in the oral floor when a well-circumscribed mass whose margin is smooth shows cystic degeneration on MRI 4 . These tumours are usually firm to hard in consistency and on section are often studded with areas of cystic degenerations, haemorrhage or lipid deposition 8 .Treatment is surgical excision and the approach depends on the location and the extent of the tumour and long-term follow-up is necessary 3 . This report is on a case of sublingual swelling found to be a Schwannoma in a young Nigerian with sonographic findings in a setting with limited diagnostic imaging techniques and a review of the literature of this rare tumour. Case Report O. S. is an 18year old secondary school student who presented July 2002 with a year history of swelling under the tongue immediately followed by small rashes and ulcers on the dorsum of the tongue. There was no associated pain, dysphagia or breathlessness. He had oral ampiclox capsules and paracetamol tablets prescribed in a primary health centre and the rashes and the small ulcers disappeared. The Sublingual Swelling progressed and three months before presentation, developed difficulty in mastication and dysphagia due to the elevation of the tongue by the swelling. Oral cavity examination revealed a sublingual swelling, about 6x 6 cm, mainly to the left of the frenulum, well circumscribed, firm in consistency, non- tender, non- fluctuant and the mucosa over it was intact and highly vascularised with restricted tongue protrusion. No palpable submental or submandibular lymph nodes. No obvious neck swelling. All other systems were essentially normal. A diagnosis of sublingual dermoid cyst was made with sublingual thyroid and thyroglossal cyst as differentials. Sublingual Ultrasound (Fig. I) showed a well-circumscribed sublingual solid mass 6x6cm on the left side of the frenulum as shown by the arrow and the right side was normal. Neck ultrasound showed normal thyroid gland. Full blood counts and electrolytes and urea with creatinine were within normal limits.
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