Management of Paranasal Sinus Schwannomas

Abstract

Schwannomas arising in the nasal cavities and paranasal sinuses are rare entities, with only sporadic cases appearing in the world literature. The lesion most commonly arises in the ethmoid and maxillary sinuses, with two cases having been reported in the sphenoid sinus. There are no reported cases of frontal sinus schwannoma. Four illustrative cases are presented which demonstrate the clinical features. The radiological investigation should include plain films and anteroposterior and lateral polytomography. Computerized tomography appears to be useful in planning surgery. An operative approach is approach is proposed which emphasizes a meticulous and complete removal of the lesion with preservation of adjacent structures and repair of any resultant dural defect.

A large sinonasal schwannoma: a rare entity

“…10 Other symptoms being facial swelling, hypoaesthesia, nasal obstruction, mucopurulent rhinorrhoea, exophthalmos and hyposmia. 6 Lesions can also present as a nasal polyp when clinically it has to be differentiated from angiofibroma and fibrotic nasal polyp. 11 In sphenold sinus schwannoma diplopia (cranial nerves involvement) and deep retroorbital and/or occipital, frontal and bitemporal pain have been reported with the possibility of hypopitutarism with posterior extension to the hypophysis.…”

“…The characteristic lesion is a well-defined mass associated with thinning of the surrounding bone by the slow growing mass. 6 CT scan is helpful in assessing the tumor size, location and erosion of bony surfaces. 13,14 MR imaging is used in lntracranial or lntraorbital extensions and delineates the neoplasm from retained secretions or inflammatory changes.…”

“…Primary involvement of the sphenoid sinus with three reported cases and frontal sinus is extremely rare. [4][5][6][7] We report a rare case of large schwannoma involving nasal cavity, maxillary sinus and sphenoid sinus and eroding the lateral wall of maxillary sinus going into infratemporal fossa and floor of the orbit. The tumour was removed by endoscopic approach.…”

Only Septal Deviation? A Tiny Schwannoma in the Nasal Septum

“…It is very important to antidiastole with septal deviation, chronic sinusitis and other up-airway diseases. Although specific diagnosis from imaging study is difficult, CT scan is helpful in evaluating the origin, localization of the tumor and involvement of vital structures (i.e., carotid artery, skull base, orbit,) around the lesion [3,4,10], thus help to choose the approach for surgical resection. As its slow growth, it can enlarge the nerve pathways and cause bone to become thin or deviated; however, commonly bone destruction does not occur.…”

“…It can arise throughout all parts of the body. Although it is not uncommon to find schwannomas in the head and neck region, this disease is comparatively rare in the nasal cavity and paranasal sinuses, previously reported multiple lesions involving the paranasal sinuses or nasal mucosa [1][2][3][4][5][7][8][9]. Herein we report the scarce case of nasal septum schwannoma without any lesion involving both mucosa and paranasal sinuses, which the out-patient diagnosis was septal deviation only.…”