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Solitary neurofibroma of the lip
Solitary neurofibroma Report
of the lip
of a case
Ja4A Traiger, B.S., D.l).S.,”
Boom, X. J’.
N
eurogenic tumors and tumorlike lesions of the mouth and jaws are rcasonably common and present many problems in relation to diagnosis, management, prognosis, and therapy. The complexity of neurogenic tumors of the fibrous type promotes a somewhat confused nomenclat,ure becaus’eof the intimate relationship of the connective nerve sheaths.l Neurofibroma, a benign tumor of nerve tissue and connective tissue, ma?occur singly or in extensive multiple form, often as part of the Von Recklinghausen neurofibromatosis syndrome. The single or solitary neurofibroma is probably a developmental malformation or hamartoma which may be found in any area of the oral mucosa.. Although this lesion may bc found in the floor ot the mouth, buccal mucosa, and palate, the tongue is the most common site. The single neurofibroma may occur at any age, but it is seen most frequently in children. Clinically, the pedunculated firm t,umor massis the type usually found on the tongue and palate. On the buccal mucosa and floor of the mouth, thr lesion appears as a nodule which is partly submerged in the submucosal Gssuc and which may be palpated as a firm, circumscribed, slightly movable mass. These tumor massesmay attain great size, particularly in children. The microscopic appearance is that of a circumscribed mass of small nerve fibers and delicate connective tissue fibrils. The connective tissue may be derived from the various nerve coats. The circumscribed mass is surrounded by a dense connective tissue, a capsular structure.? The following case of solitary neurofibroma of the upper lip is presented because of the lesion’s rare location. CASE REPORT
A lQ-year-da chief complaint and interfered
healthy-appearing Caucasian girl was first seen by me in June, 1963. Her concerned the presence of a mass on the right upper lip which was annoying with her speech in a dramatics school.
The Mount Sinai *Clinical Assistant Attending Oral Surgeon, AT. Y., and Assistant Attending Oral Surgeon, Elmhurst City Hospital,
148
Hospital, Elmhurst,
New N. I’.
York,
Volume Number
Solitary
21 2
neurofibroma
of lip
149
The lesion was a firm, circumscribed, slightly movable mass, nontender to palpation, within the tissue of the right upper lip. A tentative diagnosis of sebaceous cyst of the lip was made (Fig. 1). A local infiltration anesthetic (Xylocaine with epinephrine 1:50,000) was used, and an incision was made over the greatest mass of the lesion. By means of blunt and sharp dissection, the mass was freed of its attachments and removed (Fig. 2). There was minimal bleeding, and the wound was closed with 5-O Dermalon interrupted sutures (Fig. 3). There was little postoperative swelling and healing was complete, with no noticeable scar (Fig. 4).
Pig.
1. Preoperat.ive
Fig.
d. Operative
Fig.
3. Postoperative
view
view
showing
showing
view
circumscribed
incision
showing
area
closure
mass
and
of
within
exposure
wound
area
upper
of
right
tumor
with
lip.
mass.
5-O
Dermalon
sutures.
150
l’raiger
Pig.
4. Final
postoperative
view
showing
The pathologist’s report indicated of the type seen in Von Recklinghausen’s sent for a thorough physical examination. negative; no other lesions were found areas.
complete
healing
with
no noticeable
scarring.
that
this was a nodule consistent with neurofibroma disease. Because of this report, the patient was The final report of this examination was completel? anywhere on the body, and there were no pigmented
CONCLUSION A case of solitary neurofibroma within the upper lip has been reported. The etiology of the tumor appears to be one of disturbed embryogenesis. Complete surgical excision is the treatment of choice for the single lesion. REFERENCES
1. Shklar, G., and Meyer, I.: Neurogenic Tumors of the Mouth and Jaws, ORAL SIJRC., ORAL MED. & ORAL PATH. 16: 1075, 1963. 5. Johnson, Harvey S., Wannamaker, G. T., Humes, J. J., and Thompson, C. W.: Central Neurofibroma; Report of a Case, ORAL SURG., ORAL MED. & ORAL PATH. 12: 379, 1959. dill
White
Plnin~s
Ed.
of the lip
of a case
Ja4A Traiger, B.S., D.l).S.,”
Boom, X. J’.
N
eurogenic tumors and tumorlike lesions of the mouth and jaws are rcasonably common and present many problems in relation to diagnosis, management, prognosis, and therapy. The complexity of neurogenic tumors of the fibrous type promotes a somewhat confused nomenclat,ure becaus’eof the intimate relationship of the connective nerve sheaths.l Neurofibroma, a benign tumor of nerve tissue and connective tissue, ma?occur singly or in extensive multiple form, often as part of the Von Recklinghausen neurofibromatosis syndrome. The single or solitary neurofibroma is probably a developmental malformation or hamartoma which may be found in any area of the oral mucosa.. Although this lesion may bc found in the floor ot the mouth, buccal mucosa, and palate, the tongue is the most common site. The single neurofibroma may occur at any age, but it is seen most frequently in children. Clinically, the pedunculated firm t,umor massis the type usually found on the tongue and palate. On the buccal mucosa and floor of the mouth, thr lesion appears as a nodule which is partly submerged in the submucosal Gssuc and which may be palpated as a firm, circumscribed, slightly movable mass. These tumor massesmay attain great size, particularly in children. The microscopic appearance is that of a circumscribed mass of small nerve fibers and delicate connective tissue fibrils. The connective tissue may be derived from the various nerve coats. The circumscribed mass is surrounded by a dense connective tissue, a capsular structure.? The following case of solitary neurofibroma of the upper lip is presented because of the lesion’s rare location. CASE REPORT
A lQ-year-da chief complaint and interfered
healthy-appearing Caucasian girl was first seen by me in June, 1963. Her concerned the presence of a mass on the right upper lip which was annoying with her speech in a dramatics school.
The Mount Sinai *Clinical Assistant Attending Oral Surgeon, AT. Y., and Assistant Attending Oral Surgeon, Elmhurst City Hospital,
148
Hospital, Elmhurst,
New N. I’.
York,
Volume Number
Solitary
21 2
neurofibroma
of lip
149
The lesion was a firm, circumscribed, slightly movable mass, nontender to palpation, within the tissue of the right upper lip. A tentative diagnosis of sebaceous cyst of the lip was made (Fig. 1). A local infiltration anesthetic (Xylocaine with epinephrine 1:50,000) was used, and an incision was made over the greatest mass of the lesion. By means of blunt and sharp dissection, the mass was freed of its attachments and removed (Fig. 2). There was minimal bleeding, and the wound was closed with 5-O Dermalon interrupted sutures (Fig. 3). There was little postoperative swelling and healing was complete, with no noticeable scar (Fig. 4).
Pig.
1. Preoperat.ive
Fig.
d. Operative
Fig.
3. Postoperative
view
view
showing
showing
view
circumscribed
incision
showing
area
closure
mass
and
of
within
exposure
wound
area
upper
of
right
tumor
with
lip.
mass.
5-O
Dermalon
sutures.
150
l’raiger
Pig.
4. Final
postoperative
view
showing
The pathologist’s report indicated of the type seen in Von Recklinghausen’s sent for a thorough physical examination. negative; no other lesions were found areas.
complete
healing
with
no noticeable
scarring.
that
this was a nodule consistent with neurofibroma disease. Because of this report, the patient was The final report of this examination was completel? anywhere on the body, and there were no pigmented
CONCLUSION A case of solitary neurofibroma within the upper lip has been reported. The etiology of the tumor appears to be one of disturbed embryogenesis. Complete surgical excision is the treatment of choice for the single lesion. REFERENCES
1. Shklar, G., and Meyer, I.: Neurogenic Tumors of the Mouth and Jaws, ORAL SIJRC., ORAL MED. & ORAL PATH. 16: 1075, 1963. 5. Johnson, Harvey S., Wannamaker, G. T., Humes, J. J., and Thompson, C. W.: Central Neurofibroma; Report of a Case, ORAL SURG., ORAL MED. & ORAL PATH. 12: 379, 1959. dill
White
Plnin~s
Ed.