Trigeminal schwannoma presenting with malocclusion: A case report and review of the literature

Abstract

Background: Trigeminal schwannomas are rare tumors of the trigeminal nerve. Depending on the location, from which they arise along the trigeminal nerve, these tumors can present with a variety of symptoms that include, but are not limited to, changes in facial sensation, weakness of the masticatory muscles, and facial pain. Case Description: We present a case of a 16-year-old boy with an atypical presentation of a large trigeminal schwannoma: painless malocclusion and unilateral masticatory weakness. This case is the first documented instance; to the best of our knowledge, in which a trigeminal schwannoma has led to underbite malocclusion; it is the 19th documented case of unilateral trigeminal motor neuropathy of any etiology. We discuss this case as a unique presentation of this pathology, and the relevant anatomy implicated in clinical examination aid in further understanding trigeminal nerve pathology. Conclusion: We believe our patient’s underbite malocclusion occurred secondary to his trigeminal schwannoma, resulting in associated atrophy and weakness of the muscles innervated by the mandibular branch of the trigeminal nerve. Furthermore, understanding the trigeminal nerve anatomy is crucial in localizing lesions of the trigeminal nerve.

Focal Atrophy of the Unilateral Masticatory Muscles Caused by Trigeminal Neuropathy from the Tumor in the Foramen Ovale

“…Among the reports on unilateral trigeminal muscle atrophy, only Bertot et al [5] No effective treatment for trigeminal motor neuropathy exists yet [15]. In a previous report, there was no improvement in clinical symptoms even though the tumor size near…”

“…Several cases of trigeminal neuropathy and atrophy of masticatory muscles caused by brain tumors have been reported, but only one case evaluated the occlusal change [5].…”

Multicompartmental cystic trigeminal schwannoma as an uncommon differential diagnosis of cerebellopontine angle tumors

“…Instead of solid enhancing tumors, the heterogeneity in appearances of cystic trigeminal schwannoma is thought to be related to an increase Antoni B to Antoni A tissue ratio, as well as more dystrophic changes due to larger tumor size [2] . Although the patient's symptoms of occipital headache and subclinical ataxia can be compatible with trigeminal schwannoma [8] , the absence of innervation territory-specific symptoms such as facial pain, numbness, or masticatory muscle weakness [10] render clinical diagnosis impossible. The epidemiological characteristics of young adult male also did not provide useful clues to the final diagnosis.…”

Pediatric multicompartmental trigeminal schwannoma: illustrative case

“…1,2 Peak incidence occurs in the third and fourth decades of life; pediatric cases are exceedingly rare, with only a handful having been reported in the literature. [3][4][5][6][7] Patients may present with trigeminal nerve dysfunction, headaches, dysphagia, or diplopia (although many cases are discovered incidentally). 4 These tumors exhibit considerable anatomical heterogeneity and can originate from or involve any segment of the trigeminal nerve.…”

“…10 Resection remains the gold standard treatment, but the choice of approach is nuanced and depends largely on tumor anatomy and surgeon comfort. For both adult and pediatric multicompartmental lesions, surgical corridors may include combinations of presigmoid, frontotemporal, subtemporal/ transpetrosal, and two-stage middle and posterior fossa exposures, [2][3][4][5][6]11 with or without the addition of endonasal endoscopic 2,[12][13][14][15][16] or transfacial (transmaxillary/transmandibular) approaches to target significant infratemporal extension. 4,11,[17][18][19] Management of TS in pediatric patients presents additional challenges because of anatomical differences, the potential for impact on development, and the need to minimize blood loss.…”