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436 Rahman G.A, Alabi.B.S, Afolabi.O.A, Bramoh.K.T and Buhari.M.O Figure 1:-Ultrasound of the Sublingual Cyst He had excision of the mass done under general anaesthesia with cuffed nasotracheal intubation. Operative findings were a solid well-encapsulated sublingual mass, mainly on the left side of the frenulum but crossing the midline to the opposite side with elevation of the tongue. The postoperative period was uneventful except for the mild oedema of the tongue, which completely resolved by the 6 th post-operative day. Macroscopically, the excised mass was globular, weighed 100grammes, dark brown, encapsulated, multinodular in part and appears cystic in other parts. Cut surface mainly solid with a few cystic parts and a focus of degeneration towards the periphery. Microscopically, it showed closely packed spindled shaped cells with monomorphic cells with dark staining oval nuclei form palisade around the eosinophilic filaments (features of Schwannoma). Outpatient visits has been uneventful nearly four years after the excision with no evidence of recurrence. Discussion Schwannoma are usually solitary, encapsulated with whorled arrangement of spindle cells having a palisade or regimented appearance seen with staring technique and on electron microscopy 10 . Schwannoma is rarely observed extracranially but intracranially, incidence is reported to be high in the tongue but extremely rare in the oral floor 7 . Schwannoma cuts across ages 2, 5 , in this report, it occurred in a male patient in the second decade of life. The presenting complaints were similar to those reported for sublingual masses but no features of upper airway obstruction in this case probably due to the small size of the tumour, however, he had dysphagia with superimposed bacterial infection, which improved with antibiotic treatment. The clinical examination findings of well-circumscribed, non-tender, sublingual cysts with tongue elevation are similar to findings elsewhere 11, 6 . The ultrasound findings of a well-circumscribed
Sublingual Schwannoma in a Nigerian African-a Case Report 437 solids, globular mass with smooth edges are consistent with sonographic findings previously documented 4 . The histopathological finding of cut surfaces with cystic parts and a focus of degeneration towards the periphery is typical of Schwannomas 10 . It does not undergo spontaneous reduction or respond to radiation therapy hence complete surgical excision is the treatment of choice as done in this case and long-term follow-up is important to monitor recurrence 3 . Schwannoma is the commonest of the neurogenic tumours in the head and neck, it possesses a rare malignant counterpart, which infiltrates adjacent tissues and metastasizes 8 . Our patient is free of this nearly four years post excision. In conclusion, when a well circumscribed mass with smooth margins and cystic degeneration is seen in the sublingual space, as in this case, Schwannoma should be taken into consideration as part of the differential diagnosis, ultrasound scan could be quite useful in the diagnostic workup in an environment with limited diagnostic facilities and complete surgical excision is the treatment of choice with long term follow-up.
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