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Official Journal of the Italian Society of Maxillofacial Surgery
Frequency: 3 issues
Online ISSN 1827-1901
Padula E. 1, Cusino C. 1, Pinna V. 2
1 Department of Oral and Maxillofacial Surgery S. Bortolo Hospital, Vicenza, Italy
2 Department of Neuroradiology S. Bortolo Hospital, Vicenza, Italy
The purpose of this article is essentially to describe a clinical case of a primary malignant tumour of the mandibular nerve observed and operated in a young patient. Considering the rarity of the mandibular nerve malignant tumours we searched the medical literature for similar cases relating to our experience. The case report regards a 12-year-old boy affected by a malignant schwannoma of the mandibular nerve observed in a standard panoramic radiograph performed for a dental check and showing an osteolytic image of the mandible. The histology demonstrated a malignant neoplasm of the peripheral nerve (MPNST). Nevertheless the absence of necrosis, the utmost rarity of mytoses, the cell proliferation index, Ki67/ MIB1, very limited (about 2%) demonstrated a low degree neoplasm. The histological diagnosis was of a low degree MPNST which arose from a neurofibroma or malignant tumour of the peripheral nerve sheath, G1, arised from a neurofibroma. The surgical treatment consisted in a partial jaw bone resection and reconstruction with iliac bone graft. The wound healing was carefully performed to avoid exposures and infections and the patient was treated with hyperbaric oxygen therapy. The malignancy of the tumour and the young age of the patient imposed radical surgery. The tumour observed was a malignant schwannoma limited to the mandible, grading G1, probably arising from a neurofibroma. The surgical treatment was radical, assured with histology of the soft tissue margins till negativity for neoplastic cells. Reconstruction was performed with autogenous hip-bone graft. Our proposal is to reoperate the patient after the growth probably with a vascularized hip-bone graft and implants to restore chewing if the bone is reabsorbed in the future. The limited extension of the tumour not involving the mucous membrane, the low malignancy and the general good recovery of the young patients, induced us to attempt a bone graft technique instead of a free microvascularized flap.