Schwannoma

A facial nerve schwannoma masquerading as a vestibular schwannoma

August 31, 2008     Amit Prasai, MRCS, Stephen E.M. Jones, FRCS (ORL-HNS), Justin Cross, MRCP, FRCR, and David A. Moffat, MA, FRCS
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Abstract

Schwannoma of the facial nerve is an extremely rare condition with an incidence far lower than that of vestibular schwannoma. We discuss the case of a woman who had been diagnosed as having vestibular schwannoma and referred to our hospital. Initially, we concurred with the diagnosis, but on reassessment of magnetic resonance imaging scans before surgery, we revised the diagnosis to facial nerve schwannoma. This allowed us to counsel the patient appropriately preoperatively regarding the expected outcome. We discuss the importance of this case and the lessons to be learned from it.

Auditory brainstem response threshold differences in patients with vestibular schwannoma: A new diagnostic index

July 31, 2008     Matthew L. Bush, MD, Raleigh O. Jones, MD, and Jennifer B. Shinn, PhD
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Abstract

Auditory brainstem response (ABR) testing is less sensitive in detecting small vestibular schwannomas than medium-size tumors. Magnetic resonance imaging (MRI) is more sensitive than ABR alone for small and large tumors, but it carries with it increased cost and issues of unavailability and patient discomfort. We conducted a prospective pilot study of 7 patients with untreated MRI-proven, unilateral vestibular schwannoma to determine if we could increase the sensitivity of ABR testing in detecting small tumors. Our method involved the use of a new ABR index that is based on threshold differences. All patients underwent pure-tone audiometry followed by a determination of behavioral threshold and neurodiagnostic threshold ABR in the normal ear, which was used as a control, and in the diseased ear. Analysis of results revealed that all 7 patients had an abnormal ABR threshold difference, and 5 patients displayed abnormal traditional ABR indices. The mean difference between the ABR and behavioral click thresholds was 41.4 dB in the diseased ears (with the ABR threshold being higher than the click threshold) and 15.8 dB in the normal ears. None of the control ears had a threshold difference >30 dB.

Vocal fold paralysis secondary to a jugular foramen schwannoma

September 30, 2007     Enrique Palacios, MD, FACR
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Vocal fold paralysis can be caused by deficits in the superior laryngeal nerve, recurrent laryngeal nerve, or the complete vagal nerve. When it occurs, the radiologist should examine the neck for the presence of a lesion along the course of the vagus nerve (cranial nerve X), which passes through the pars nervosa of the jugular foramen and along the carotid sheath

Paranasal sinus melanoma masquerading as chronic sinusitis and nasal polyposis

August 31, 2007     Brian Kung, MD; Geoffrey R. Deschenes, BA; William Keane, MD; Mary Cunnane, MD; Marie-Paule Jacob-Ampuero, MD; Marc Rosen, MD
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Abstract
Malignant melanoma of the nose and paranasal sinuses can be a devastating disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. It is an uncommon process, often misdiagnosed both clinically and pathologically. We present the case of an 80-year-old man who had a 2-month history of progressively worsening left-sided epistaxis and nasal obstruction. Radiographic evidence indicated the presence of soft tissue in the left maxillary sinus and nasal cavity resembling massive nasal polyposis and chronic fungal sinusitis. Magnetic resonance imaging was not performed because the patient had a pacemaker. After endoscopic debridement of the soft-tissue mass, frozen-section analysis detected no evidence of tumor. The final pathologic diagnosis was malignant melanoma. Otolaryngologists should be familiar with the difficulties inherent in the diagnosis and management of sinonasal melanomas.

Transcranial trigeminal schwannoma

August 31, 2007     Daniel H. Coelho, MD; Nilesh Vasan, MD, FRACS
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A 51-year-old man fell while hiking and sustained a mild concussion and a fractured lower leg. Computed tomography (CT) of the head detected no intracranial pathology, but it did incidentallyshow a mass in the right infratemporal fossa. 

Schwannoma of the tonsil

May 31, 2007     Byung-Joo Lee, MD, PhD; Soo-Geun Wang, MD, PhD; Jin-Choon Lee, MD, PhD; Il-Woo Lee, MD, PhD
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Abstract

Between 25 and 48% of schwannomas have been reported to occur in the head and neck region; the acoustic nerve is involved in most cases. Schwannomas arising in the tonsil are extremely uncommon. We report a case of tonsillar schwannoma in a 23-year-old woman. We also review the literature on this rare entity.

Schwannoma of the nasal cavity

March 31, 2007     Amee Dharia, MD; Collin S. Karmody, MD; Elie E. Rebeiz, MD, FACS
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Facial nerve schwannoma presenting as a tympanic mass

May 31, 2006     Sejal P. Sarolia, BS; Christopher J. Danner, MD; Eren Erdem, MD

Inferior turbinate schwannoma: Report of a case

May 31, 2006     Riad Khnifies, MD; Milo Fradis, MD; Alexander Brodsky, MD; Jacob Bajar, MD; Michal Luntz, MD
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Abstract
Schwannomas of the nasal cavity are extremely rare. We evaluated a 42-year-old woman who presented with a 4-year history of slowly progressive nasal obstruction. The cause of the obstruction was identified as a schwannoma in the left inferior turbinate. The tumor was completely excised, and no sign of recurrence was evident at the 1-year follow-up. To the best of our knowledge, this is only the third case of a schwannoma originating in the inferior nasal turbinate that has been reported in the English-language literature. We review the clinical and pathologic features of this case.

Schwannoma of the true vocal fold: A rare diagnosis

January 1, 2006     Jennifer Taylor, BS; Marc Stiefel, MD; Steven Y. Park, MD
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Abstract
Schwannomas of the larynx are rare, benign, slowly growing tumors. When they do occur, they are most often isolated in the aryepiglottic folds or false vocal folds. When a tumor originates in the larynx, it typically causes hoarseness and a globus sensation. As the tumor expands, it may cause dyspnea, stridor, and possibly asphyxiation as a result of the mass effect. In this article, we report an unusual case of a schwannoma of the true vocal fold in a young woman.

Schwannoma of the larynx: A case report

November 1, 2005     Farahnaz Syeda, MS; Akhtar Hussain, FRCS
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Abstract
Neurogenic tumors of the larynx are rare. We report a case of supraglottic schwannoma in a 59-year-old woman. We excised the tumor via a lateral thyrotomy approach.

Schwannoma of the larynx

August 31, 2005     Wai-kuen Ho, FACS, FRCS; Stephen D.C. Lo, MBBS, DLO; Raymond W.M. Ng, FRCS
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