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CURRENT ISSUEITALIAN JOURNAL OF MAXILLOFACIAL SURGERY

A Journal on Maxillofacial Surgery

Official Journal of the Italian Society of Maxillofacial Surgery

Frequency: 3 issues

ISSN 1120-7558

Online ISSN 1827-1901

 

Rivista Italiana di Chirurgia Maxillo-Facciale 2002 December;13(3):173-7

    CLINICAL CASES

Primary malignant tumour of the mandibular nerve

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.

language: English


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