- Email: [email protected]
Neurilemmoma of the mandible
330
NON-HODGKIN’S
blastic lymphoma (Working Formulation) (Figs. 2, 3).
was made
Discussion Kaposi’s sarcoma has been associated with AIDS since the disease was first described in 1981 by the Center for Disease Control. Nonoral lymphomas were first reported in patients with AIDS in 1982.7y8Several reports have noted the coexistence of Kaposi’s sarcoma and non-Hodgkin’s lymphoma in AIDS patients.9 This report describes the presence of an intraoral lymphoma in a patient with AIDS-related Kaposi’s sarcoma on the skin. It is believed to be the first reported case of a primary extranodal lymphoma in an intraoral location associated with AIDS. This case report emphasizes several aspects of diagnosing oral disease in AIDS patients. First, AIDS patients are prone to several life threatening diseases. Second, an intraoral lesion with the clinical presentation of Kaposi’s sarcoma may be an expression of a different disease. Third, performing biopsies on oral lesions allow a definitive method of identifying the true nature of those lesions. It is suggested that the diagnostic evaluation of AIDS patients should include biopsies of any suspi-
J Oral Maxillofac 46330-334,
LYMPHOMA WITH AIDS
cious intraoral lesions because, as in this case, a clinical lesion that appeared to be a Kaposi’s sarcoma was histologically determined to be a lymphoma. This distinction was important because it significantly affected the choice of medical treatment.
References 1. Morbidity and Mortality Weekly Report 36:273, 1987 2. Morbidity and Mortality Weekly Report 35:757. 1986 3. Silverman S Jr, Migliorati CA, Lozada-Nur F. et al: Oral findings in people with or at high risk for AIDS: A study of 375 homosexual males. J Am Dent Assoc 112:187. 1986 4. Anneroth G. Anneroth I, Lynch DP: Acquired immune de% ciencv svndrome (AIDS) in the United States in 1986. J Oral Maxillofac Surg 44:956, 1986 5. Lind SE, Gross PL, Andiman WA, et al: Malignant lymphoma presenting as Kaposi’s sarcoma in a homosexual man with the acquired immunodeficiency syndrome. Ann Intern Med 102:338. 1985 6. Wilson TG. Wright JM: Non-Hodgkin’s lymphoma of the gingiva: Review of the literature. J Periodontol 57:155, 1986 7. Doll DC, List AF: Burkitt’s lymphoma in a homosexual. Lancet 1:1026. 1986 8. Ziegler JL, Miner RC, Rosenbaum E. et al. Outbreak of Burkitt’s-like lymphoma among homosexual men. Lancet 2:631, 1982 9. Kalter SP. Riggs SA. Cabanillas F, et al: Aggressive nonHodgkin’s lymphoma in immunocompromised homosexual males. Blood 66:655. 1985
Surg
1966
Neurilemmoma CL6VIS
of the Mandible
MARZOLA, CD, DC, LD, P ADJ,* MOACIR J. BORGUETTI, ALBERT0 CONSOLARO, CD, MS-t
Neurilemmoma (Schwannoma) is a rare benign tumor probably originating from the Schwann cells
CD,* AND
of the neural sheath, which may arise from any myelinated nerve fiber. Neurilemmomas involving soft tissues are more common than intraosseous lesions, and rarely seen in the oral cavity. The following report describes a patient with a large mandibular lesion.
Received from the Departments of *Oral and Maxillofacial Surgery and tOral Pathology, University of Sao Paula, School of Dentistry of Bauru, and Marilia. SBo Wulo, Brazil. Address correspondence and reprint requests to Dr. Marzola: Professor Adjunto of Department of Oral and Maxillofacial Surgery, School of dentistry of Bauru, University of Sao Paulo. Brazil. Al. Dr. Octavia Pinheiro Brisolla, 9-75 17043, Bauru, S&o Paula, Brazil. @ 1988 American Association of Oral and Maxiilofacial Surgeons
swelling of the anterior mandible, with concomitant gration of the teeth. Medical and family histories
0278-2391188 $0.00 + .25
noncontributory.
Report of a Case A 16-year-old black man first came to the Surgery Department of the Marilia School of Dentistry (Marilia. St. Paul, Brazil) in I983 for treatment of an expanding mi-
were
MARZOLA ET AL.
FIGURE 1. Clinical views of the large palpable swelling located in the midline of the mandible. Top.
profile view showing expansion in the symphyseal re-
331
FIGURE 2. The panoramic (fop) and lateral (bottom) radiographs of the mandible, reveal a large, well-demarcated unilocular radiolucent lesion of the mandibular symphysis.
gion. Bottom, close-up view showing prominence of the chin.
Clinically, a large palpable swelling was located in the midline of the mandible (Fig. 1). The panoramic and lateral radiographs of the mandible (Fig. 2) revealed a large, well-demarcated, locular, radiolucent lesion of the mandibular symphysis with sclerotic margins. All the anterior teeth which had migrated, were present, and responded appropriately to electrical stimulation. The general health of the patient was good. Aspiration with an l&gauge needle was negative for blood or cystic fluid. Laboratory tests for hyperparathyroidism were within normal limits. Under local anesthesia, an extraoral incision was made at the inferior border of the mandible, and the lesion was
exposed (Fig. 3). The tumor was solid and could be easily shelled out (Fig. 4). It was multilocular, encapsulated, and measured approximately 70 mm in diameter. The lingual cortical plate of bone was thin but not perforated. The tumor did not appear to be associated with the mandibular nerve. After careful curettage of the bone cavity, the cutaneous flap was replaced and sutured (Fig. 5). The postoperative course was uneventful and the patient was discharged a week later. Microscopically the neoplasm consisted of two distinct types of tissue arrangements. The first formed by elongated and fusiform cells arranged in palisade fashion, with the intercellular fibers following the same direction was consistent with Antoni type A tissue (Fig. 6). In the middle of these cylindrical and spiral-like cell formations.
332
NEURILEMMOMA
FIGURE 3 (top). exposed.
Intraoperative Appearance
FIGURE 4 (middle). removal. FIGURE patient.
a second type of tissue arrangement, Antoni type B, was seen in which cells and fibers were randomly distributed (Fig. 7). Verocay bodies were also present. The diagnosis .. was neurilemmoma. The patient has been followed for 4 years.
5 (bottom).
Immediate
OF THE MANDIBLE
view showing the lesion was of,the lesion just prior to postoperative
view of the
DlSCUSSlON Some authors group solitary neurofibromas and lleurilemmomas together, but the majority regard them
as two distinct
entities.
Anderson’
describes
333
MARZOLA ET AL
FIGURE 6 (top). Antoni type A tissue (A) formed by elongated and fusiform cells arranged in palisade and intercellular fibers following the same direction. Arrow indicates a verocay body.
FIGURE 7 (bottom). Antoni type B tissue (B) formed by randomly distributed cells and fibers. Arrow indicates an area of Antoni type A tissue.
differing histologic pictures but states that “neurilemmomas should probably be regarded as variants of neurofibromas.” Willis2 believes that “we might expect to encounter tumors of distinctive Schwann’s cell-type, others of nondistinctive mesenchymal type, and others of associated, combined, or transitional type.” Adding to the confusion is the variety of terms used to describe these lesions, such as neurofibroma, neurilemmoma, neurinoma, and perineural fibroblastoma. Das Gupta et aL3 reported a series of 303 cases of benign solitary neurogenic tumors (including neurilemmomas and neurofibromas). In their series, 44.8% of the tumors were located in the head and neck region. Hatziotis and Asprides reviewed the literature from 1945 to 1964 on oral soft tissue neurilemmomas, analyzing 106 cases, and added four cases of their own. According to them, both male and female are equally affected, and 67% of the cases analyzed occurred between the ages of 10 and 29 years.
Neurilemmomas affecting bone seem to be extremely rare. Fawcett and Dahlin5 found only seven intraosseous neurilemmomas in a series comprising 3,987 histologically verified primary bone tumors. Of these seven cases, four were located in the mandible. They also reviewed the literature and reported 36 neurilemmomas involving the skeleton. including their own cases. Eversole reported 17 neurilemmomas in the mandible and one in the maxilla in a review of 18 central neurilemmomas of the jaws. Ide et al.’ found 24 acceptable cases and added one new case of their own. The mandible (22 cases) was the most common location of neurilemmoma of the jaws, with a predilection for the molar-ramus region (17 cases). All three cases involving the maxilla were found in the anterior region. Satterfield et a1.8 reviewed central schwannomas reported in literature and added one new case of their own. Hietanen et a1.21reported two cases involving the posterior part of the mandible. These two neurilemmomas recurred, probably due to incomplete removal of the tumor. Other authors reporting on neurilemmomas include Baetz and Shackleford,’ Samter”, Morgan and Spilka, lo Helsham,” Morgan, I3 Shimura et al.14 Sugimura et al.,lS Swanand gilpa et al., I6 Ellis et al., l7 Rengaswamy,i8 Schofield and Gardner.19 To the best of our knowledge, the number of published central neurilemmomas involving the jaws totals 28 cases.21 The clinical appearance of these tumors varies in size from 3 x 4 mm to 70 x 50 mm, with the majority measuring less than 20 mm in diameter. They generally appear as sessile nodules that vary in color from normal mucosal pink to red or yellow. The duration prior to treatment ranges from 5 months to 49 years, with 45% of the tumors having been present for less than I year. Only 4% of neurofibromas are encapsulated or well delineated, whereas 100% of neurilemmomas displayed these features. Only one of Cherrick and Eversoles 37 cases showed recurrence, and this one recurred four times. None have undergone malignant transformation. 17,18Enucleation appears to be currative in most cases. References I. Anderson WAD: Pathology, 4th ed. St. Louis, CV Mosby. 1961. p 1323 2. Willis RA: Pathology of Turnours. 3rd ed. London, Butterworth, 1953, pp 832-844 3. Das Gupta TK, et al: Benign solitary schwannoma (neurilemmomas). Cancer 24:355, 1969 4. Hatziotis JC. Asprides H: Neurilemmoma (schwannoma) of the oral cavity. Oral Surg 24510. 1967 5. Fawcett KJ, Dahlin DC: Neurilemmoma of bone. Am J Clin Pathol 47:759. 1967
334
NEURILEMMOMA
6. Eversole LR: Central benign and malignant neural neoplasms of the jaws: A review. J Oral Surg 27:716. 1969 7. Ide F. et al: Central neurilemmoma of the literature. J Nihon Univ Sch Dent 19:59, 1977 8. Sattetield SD, et al: Mandibular central schwannoma: Report of case. J Oral Surg 39:776, 1981 9. Baetz FO, Shackleford JA: Schwannoma of the inferior alveolar nerve: Report of case. J Oral Surg 9:33 I, 195I 10. Spilka CJ: Neurilemmoma (schwannoma): Report of case. J Oral Surg 11:245. 1953 11. Helsham RW: Schwannoma. Aust Dent J I: 112, 1956 12. Samter TG, et al: Neurilemmoma of bone: Report of three cases with a review of the literature. Radiology, 75:215, 1960 13. Morgan GA, Morgan PR: Neurilemmoma-neurofibroma. Oral Surg 25:182, 1968 14. Shimura K, et al: Central neurilemmoma of the mandible:
J Oral Maxillofac 46:334-336,
15. 16. 17. 18. 19. 20.
21.
OF THE MANDIBLE
Report of case and review of the literature. J Oral Surg 31:363, 1973 Sugimura M, et al: A case of neurilemmoma in the mandible. Int J Oral Surg 3: 194, 1974 Swangsilpa D, et al: Neurilemmoma in the oral cavity. J Dent 41237, 1976 Ellis GL, et al: Interosseous benign neural sheath neoplasms of the jaws. Oral Surg 44:731, 1977 Rengaswamy V: Central neurilemmoma of the jaws. Int J Oral Surg 7:300. 1978 Schofield IDF, Gardner DG: Central neurilemmoma of the mandible. Can Dent Assoc J 47:175, 1981 Cherrick HM, Eversole LR: Benign neural sheath neoplasm of the oral cavity. Report of 37 cases. Oral Surg 32:900, 1971 Hietanen J, et al: Central neurilemmomas of the mandible. Report of a case. lnt J Oral Surg 13: 166, 1984
Surg
1980
Ameloblastoma Presenting as a Unilateral Nasal Obstruction JED A. KWARTLER,
MD,* JAMES LABAGNARA,
Ameloblastoma is a rare tumor, comprising 1% of tumors and cystic lesions of the mandible and maxilla. When present in the maxilla, it may extend to involve surrounding structures, including the maxillary sinus, nasal vestibule, nasopharynx, orbit, and skull base,1-6 although an oral presentation is more common. We report a case of a maxillary ameloblastoma presenting as progressive unilateral nasal obstruction of 6 months duration, without a prior history of dental complaints. Report of a Case A 54-year-old black man was seen by the otolaryngology service with a complaint of progressive unilateral nasal obstruction of 6 months duration. He denied any
Received from the Department of Otolaryngology-Head and Neck Surgery, UMDNJ-New Jersey Medical School, Newark. New Jersey. *Resident. tClinica1 Assistant Professor. SClinical Assistant Professor, Department of Pathology; Director of Laboratories, United Hospitals Medical Center, Newark, New Jersey. Address correspondence and reprint requests to Dr. Kwartler: 36 Warren Court. South Orange. NJ 07079. 0 1988 American geons 0278-2391188
Associati&
$0.00 + .25
‘of Oral and Maxillofacial
Sur-
JR, MD,t AND NEENA MIRANI, MD+-
episodes of epistaxis. On anterior rhinoscopy, the left nasal airway was widely patent, and no ulcerations or lesions of the septum were noted. The right nasal cavity was totally occluded by a polypoid soft tissue mass; no discrete point of attachment could be identified. The oral cavity was free of lesions, and no abnormalities of the maxillary dentition and hard and soft palate were noted. The malar soft tissues were not swelling, nor were any cranial nerve deficits noted. A biopsy of the mass was performed, and was reported as being consistent with ameloblastoma. A computerized axial tomographic scan with contrast demonstrated a nonenhancing mass of the right nares extending to, and causing total opacification of, the right maxillary, ethmoid, and sphenoid sinuses (Fig. 1). The medial wall and posterior wall of the right maxillary sinus showed evidence of displacement as well as bony erosion, and communication posteriorly into the pterygomaxillary space was observed. Magnified views of the sella turcica were unremarkable. No intracranial extension was noted. A panoramic radiograph showed a unilocular cystic lesion in the maxillary alveolus involving the root of the maxillary right second molar (Fig. 2). Magnetic resonance imaging examination performed in the axial, coronal, and sagittal planes at T, weighted parameters demonstrated a large mixed signal intensity mass filling the right maxillary antrum, causing convex bowing of all the walls of the sinus, with extension posteriorly into the pterygomaxillary space (Fig. 3). The mass extended to involve the ipsilateral ethmoid and sphenoid sinuses. No abnormalities of the pituitary were noted. The patient underwent a right maxillectomy. external sphenoethmoidectomy, and dacrocystorhinostomy
NON-HODGKIN’S
blastic lymphoma (Working Formulation) (Figs. 2, 3).
was made
Discussion Kaposi’s sarcoma has been associated with AIDS since the disease was first described in 1981 by the Center for Disease Control. Nonoral lymphomas were first reported in patients with AIDS in 1982.7y8Several reports have noted the coexistence of Kaposi’s sarcoma and non-Hodgkin’s lymphoma in AIDS patients.9 This report describes the presence of an intraoral lymphoma in a patient with AIDS-related Kaposi’s sarcoma on the skin. It is believed to be the first reported case of a primary extranodal lymphoma in an intraoral location associated with AIDS. This case report emphasizes several aspects of diagnosing oral disease in AIDS patients. First, AIDS patients are prone to several life threatening diseases. Second, an intraoral lesion with the clinical presentation of Kaposi’s sarcoma may be an expression of a different disease. Third, performing biopsies on oral lesions allow a definitive method of identifying the true nature of those lesions. It is suggested that the diagnostic evaluation of AIDS patients should include biopsies of any suspi-
J Oral Maxillofac 46330-334,
LYMPHOMA WITH AIDS
cious intraoral lesions because, as in this case, a clinical lesion that appeared to be a Kaposi’s sarcoma was histologically determined to be a lymphoma. This distinction was important because it significantly affected the choice of medical treatment.
References 1. Morbidity and Mortality Weekly Report 36:273, 1987 2. Morbidity and Mortality Weekly Report 35:757. 1986 3. Silverman S Jr, Migliorati CA, Lozada-Nur F. et al: Oral findings in people with or at high risk for AIDS: A study of 375 homosexual males. J Am Dent Assoc 112:187. 1986 4. Anneroth G. Anneroth I, Lynch DP: Acquired immune de% ciencv svndrome (AIDS) in the United States in 1986. J Oral Maxillofac Surg 44:956, 1986 5. Lind SE, Gross PL, Andiman WA, et al: Malignant lymphoma presenting as Kaposi’s sarcoma in a homosexual man with the acquired immunodeficiency syndrome. Ann Intern Med 102:338. 1985 6. Wilson TG. Wright JM: Non-Hodgkin’s lymphoma of the gingiva: Review of the literature. J Periodontol 57:155, 1986 7. Doll DC, List AF: Burkitt’s lymphoma in a homosexual. Lancet 1:1026. 1986 8. Ziegler JL, Miner RC, Rosenbaum E. et al. Outbreak of Burkitt’s-like lymphoma among homosexual men. Lancet 2:631, 1982 9. Kalter SP. Riggs SA. Cabanillas F, et al: Aggressive nonHodgkin’s lymphoma in immunocompromised homosexual males. Blood 66:655. 1985
Surg
1966
Neurilemmoma CL6VIS
of the Mandible
MARZOLA, CD, DC, LD, P ADJ,* MOACIR J. BORGUETTI, ALBERT0 CONSOLARO, CD, MS-t
Neurilemmoma (Schwannoma) is a rare benign tumor probably originating from the Schwann cells
CD,* AND
of the neural sheath, which may arise from any myelinated nerve fiber. Neurilemmomas involving soft tissues are more common than intraosseous lesions, and rarely seen in the oral cavity. The following report describes a patient with a large mandibular lesion.
Received from the Departments of *Oral and Maxillofacial Surgery and tOral Pathology, University of Sao Paula, School of Dentistry of Bauru, and Marilia. SBo Wulo, Brazil. Address correspondence and reprint requests to Dr. Marzola: Professor Adjunto of Department of Oral and Maxillofacial Surgery, School of dentistry of Bauru, University of Sao Paulo. Brazil. Al. Dr. Octavia Pinheiro Brisolla, 9-75 17043, Bauru, S&o Paula, Brazil. @ 1988 American Association of Oral and Maxiilofacial Surgeons
swelling of the anterior mandible, with concomitant gration of the teeth. Medical and family histories
0278-2391188 $0.00 + .25
noncontributory.
Report of a Case A 16-year-old black man first came to the Surgery Department of the Marilia School of Dentistry (Marilia. St. Paul, Brazil) in I983 for treatment of an expanding mi-
were
MARZOLA ET AL.
FIGURE 1. Clinical views of the large palpable swelling located in the midline of the mandible. Top.
profile view showing expansion in the symphyseal re-
331
FIGURE 2. The panoramic (fop) and lateral (bottom) radiographs of the mandible, reveal a large, well-demarcated unilocular radiolucent lesion of the mandibular symphysis.
gion. Bottom, close-up view showing prominence of the chin.
Clinically, a large palpable swelling was located in the midline of the mandible (Fig. 1). The panoramic and lateral radiographs of the mandible (Fig. 2) revealed a large, well-demarcated, locular, radiolucent lesion of the mandibular symphysis with sclerotic margins. All the anterior teeth which had migrated, were present, and responded appropriately to electrical stimulation. The general health of the patient was good. Aspiration with an l&gauge needle was negative for blood or cystic fluid. Laboratory tests for hyperparathyroidism were within normal limits. Under local anesthesia, an extraoral incision was made at the inferior border of the mandible, and the lesion was
exposed (Fig. 3). The tumor was solid and could be easily shelled out (Fig. 4). It was multilocular, encapsulated, and measured approximately 70 mm in diameter. The lingual cortical plate of bone was thin but not perforated. The tumor did not appear to be associated with the mandibular nerve. After careful curettage of the bone cavity, the cutaneous flap was replaced and sutured (Fig. 5). The postoperative course was uneventful and the patient was discharged a week later. Microscopically the neoplasm consisted of two distinct types of tissue arrangements. The first formed by elongated and fusiform cells arranged in palisade fashion, with the intercellular fibers following the same direction was consistent with Antoni type A tissue (Fig. 6). In the middle of these cylindrical and spiral-like cell formations.
332
NEURILEMMOMA
FIGURE 3 (top). exposed.
Intraoperative Appearance
FIGURE 4 (middle). removal. FIGURE patient.
a second type of tissue arrangement, Antoni type B, was seen in which cells and fibers were randomly distributed (Fig. 7). Verocay bodies were also present. The diagnosis .. was neurilemmoma. The patient has been followed for 4 years.
5 (bottom).
Immediate
OF THE MANDIBLE
view showing the lesion was of,the lesion just prior to postoperative
view of the
DlSCUSSlON Some authors group solitary neurofibromas and lleurilemmomas together, but the majority regard them
as two distinct
entities.
Anderson’
describes
333
MARZOLA ET AL
FIGURE 6 (top). Antoni type A tissue (A) formed by elongated and fusiform cells arranged in palisade and intercellular fibers following the same direction. Arrow indicates a verocay body.
FIGURE 7 (bottom). Antoni type B tissue (B) formed by randomly distributed cells and fibers. Arrow indicates an area of Antoni type A tissue.
differing histologic pictures but states that “neurilemmomas should probably be regarded as variants of neurofibromas.” Willis2 believes that “we might expect to encounter tumors of distinctive Schwann’s cell-type, others of nondistinctive mesenchymal type, and others of associated, combined, or transitional type.” Adding to the confusion is the variety of terms used to describe these lesions, such as neurofibroma, neurilemmoma, neurinoma, and perineural fibroblastoma. Das Gupta et aL3 reported a series of 303 cases of benign solitary neurogenic tumors (including neurilemmomas and neurofibromas). In their series, 44.8% of the tumors were located in the head and neck region. Hatziotis and Asprides reviewed the literature from 1945 to 1964 on oral soft tissue neurilemmomas, analyzing 106 cases, and added four cases of their own. According to them, both male and female are equally affected, and 67% of the cases analyzed occurred between the ages of 10 and 29 years.
Neurilemmomas affecting bone seem to be extremely rare. Fawcett and Dahlin5 found only seven intraosseous neurilemmomas in a series comprising 3,987 histologically verified primary bone tumors. Of these seven cases, four were located in the mandible. They also reviewed the literature and reported 36 neurilemmomas involving the skeleton. including their own cases. Eversole reported 17 neurilemmomas in the mandible and one in the maxilla in a review of 18 central neurilemmomas of the jaws. Ide et al.’ found 24 acceptable cases and added one new case of their own. The mandible (22 cases) was the most common location of neurilemmoma of the jaws, with a predilection for the molar-ramus region (17 cases). All three cases involving the maxilla were found in the anterior region. Satterfield et a1.8 reviewed central schwannomas reported in literature and added one new case of their own. Hietanen et a1.21reported two cases involving the posterior part of the mandible. These two neurilemmomas recurred, probably due to incomplete removal of the tumor. Other authors reporting on neurilemmomas include Baetz and Shackleford,’ Samter”, Morgan and Spilka, lo Helsham,” Morgan, I3 Shimura et al.14 Sugimura et al.,lS Swanand gilpa et al., I6 Ellis et al., l7 Rengaswamy,i8 Schofield and Gardner.19 To the best of our knowledge, the number of published central neurilemmomas involving the jaws totals 28 cases.21 The clinical appearance of these tumors varies in size from 3 x 4 mm to 70 x 50 mm, with the majority measuring less than 20 mm in diameter. They generally appear as sessile nodules that vary in color from normal mucosal pink to red or yellow. The duration prior to treatment ranges from 5 months to 49 years, with 45% of the tumors having been present for less than I year. Only 4% of neurofibromas are encapsulated or well delineated, whereas 100% of neurilemmomas displayed these features. Only one of Cherrick and Eversoles 37 cases showed recurrence, and this one recurred four times. None have undergone malignant transformation. 17,18Enucleation appears to be currative in most cases. References I. Anderson WAD: Pathology, 4th ed. St. Louis, CV Mosby. 1961. p 1323 2. Willis RA: Pathology of Turnours. 3rd ed. London, Butterworth, 1953, pp 832-844 3. Das Gupta TK, et al: Benign solitary schwannoma (neurilemmomas). Cancer 24:355, 1969 4. Hatziotis JC. Asprides H: Neurilemmoma (schwannoma) of the oral cavity. Oral Surg 24510. 1967 5. Fawcett KJ, Dahlin DC: Neurilemmoma of bone. Am J Clin Pathol 47:759. 1967
334
NEURILEMMOMA
6. Eversole LR: Central benign and malignant neural neoplasms of the jaws: A review. J Oral Surg 27:716. 1969 7. Ide F. et al: Central neurilemmoma of the literature. J Nihon Univ Sch Dent 19:59, 1977 8. Sattetield SD, et al: Mandibular central schwannoma: Report of case. J Oral Surg 39:776, 1981 9. Baetz FO, Shackleford JA: Schwannoma of the inferior alveolar nerve: Report of case. J Oral Surg 9:33 I, 195I 10. Spilka CJ: Neurilemmoma (schwannoma): Report of case. J Oral Surg 11:245. 1953 11. Helsham RW: Schwannoma. Aust Dent J I: 112, 1956 12. Samter TG, et al: Neurilemmoma of bone: Report of three cases with a review of the literature. Radiology, 75:215, 1960 13. Morgan GA, Morgan PR: Neurilemmoma-neurofibroma. Oral Surg 25:182, 1968 14. Shimura K, et al: Central neurilemmoma of the mandible:
J Oral Maxillofac 46:334-336,
15. 16. 17. 18. 19. 20.
21.
OF THE MANDIBLE
Report of case and review of the literature. J Oral Surg 31:363, 1973 Sugimura M, et al: A case of neurilemmoma in the mandible. Int J Oral Surg 3: 194, 1974 Swangsilpa D, et al: Neurilemmoma in the oral cavity. J Dent 41237, 1976 Ellis GL, et al: Interosseous benign neural sheath neoplasms of the jaws. Oral Surg 44:731, 1977 Rengaswamy V: Central neurilemmoma of the jaws. Int J Oral Surg 7:300. 1978 Schofield IDF, Gardner DG: Central neurilemmoma of the mandible. Can Dent Assoc J 47:175, 1981 Cherrick HM, Eversole LR: Benign neural sheath neoplasm of the oral cavity. Report of 37 cases. Oral Surg 32:900, 1971 Hietanen J, et al: Central neurilemmomas of the mandible. Report of a case. lnt J Oral Surg 13: 166, 1984
Surg
1980
Ameloblastoma Presenting as a Unilateral Nasal Obstruction JED A. KWARTLER,
MD,* JAMES LABAGNARA,
Ameloblastoma is a rare tumor, comprising 1% of tumors and cystic lesions of the mandible and maxilla. When present in the maxilla, it may extend to involve surrounding structures, including the maxillary sinus, nasal vestibule, nasopharynx, orbit, and skull base,1-6 although an oral presentation is more common. We report a case of a maxillary ameloblastoma presenting as progressive unilateral nasal obstruction of 6 months duration, without a prior history of dental complaints. Report of a Case A 54-year-old black man was seen by the otolaryngology service with a complaint of progressive unilateral nasal obstruction of 6 months duration. He denied any
Received from the Department of Otolaryngology-Head and Neck Surgery, UMDNJ-New Jersey Medical School, Newark. New Jersey. *Resident. tClinica1 Assistant Professor. SClinical Assistant Professor, Department of Pathology; Director of Laboratories, United Hospitals Medical Center, Newark, New Jersey. Address correspondence and reprint requests to Dr. Kwartler: 36 Warren Court. South Orange. NJ 07079. 0 1988 American geons 0278-2391188
Associati&
$0.00 + .25
‘of Oral and Maxillofacial
Sur-
JR, MD,t AND NEENA MIRANI, MD+-
episodes of epistaxis. On anterior rhinoscopy, the left nasal airway was widely patent, and no ulcerations or lesions of the septum were noted. The right nasal cavity was totally occluded by a polypoid soft tissue mass; no discrete point of attachment could be identified. The oral cavity was free of lesions, and no abnormalities of the maxillary dentition and hard and soft palate were noted. The malar soft tissues were not swelling, nor were any cranial nerve deficits noted. A biopsy of the mass was performed, and was reported as being consistent with ameloblastoma. A computerized axial tomographic scan with contrast demonstrated a nonenhancing mass of the right nares extending to, and causing total opacification of, the right maxillary, ethmoid, and sphenoid sinuses (Fig. 1). The medial wall and posterior wall of the right maxillary sinus showed evidence of displacement as well as bony erosion, and communication posteriorly into the pterygomaxillary space was observed. Magnified views of the sella turcica were unremarkable. No intracranial extension was noted. A panoramic radiograph showed a unilocular cystic lesion in the maxillary alveolus involving the root of the maxillary right second molar (Fig. 2). Magnetic resonance imaging examination performed in the axial, coronal, and sagittal planes at T, weighted parameters demonstrated a large mixed signal intensity mass filling the right maxillary antrum, causing convex bowing of all the walls of the sinus, with extension posteriorly into the pterygomaxillary space (Fig. 3). The mass extended to involve the ipsilateral ethmoid and sphenoid sinuses. No abnormalities of the pituitary were noted. The patient underwent a right maxillectomy. external sphenoethmoidectomy, and dacrocystorhinostomy