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Clinical Problem Solving: Radiology
February 2007

Radiology Quiz Case 1: Diagnosis

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(2):196. doi:10.1001/archotol.133.2.196

The computed tomographic scan revealed an expansile soft tissue mass, measuring approximately 2 cm in diameter, predominantly in the ramus of the right mandible. The mass exhibited heterogeneous enhancement, with bowing of the posterior wall of the right maxillary sinus and probable involvement of the right lateral pterygoid muscle. The initial clinical diagnosis was odontogenic neoplasm. An incisional biopsy, however, revealed a neurogenic neoplasm containing numerous Verocay bodies, indicating a diagnosis of neurofibroma or, especially, schwannoma. On the basis of these findings, the decision was made to proceed with excision of the mass. A 4-cm incision was made in the buccal mucosa and extended medially to the mandible; the tan, fleshy, lobulated tumor was bluntly dissected from its cavity. The mass was not tightly adherent to the underlying remodeled mandibular bone. The course of the inferior alveolar nerve was not identified. The incision was closed. The findings of pathologic examination of the specimen were consistent with a schwannoma.