Clinical Features and Surgical Treatment of Schwannoma Affecting the Base of the Tongue: A Systematic Review

Abstract

Introduction Schwannomas of the head and neck account for 25-40% of all cases, with presentation at the base of the tongue as the most frequent site for intraoral tumors. Objectives Here, a systematic review was conducted to include 15 cases of patients with schwannoma of the base of the tongue. Data Synthesis Most patients presented with a single, painless, well-encapsulated nodule at the base of the tongue. These nodules were slow-growing, with an average of 13.3 months from onset to presentation. Most cases were accompanied by airway obstruction, indicated by symptoms of dysphagia, dysarthria, snoring, and sleep apnea. Overall, the histological studies were consistent with a benign schwannoma with a palisading Antoni A and Antoni B pattern without malignant changes in cell morphology. These tumors were treated via complete surgical excision, and all cases achieved full remission by final follow-up. Conclusion Surgical removal is the primary mode of treatment with excellent postoperative prognosis and rare instances of recurrence. Given the rarity of this tumor, this review of available case studies serves to comprehensively describe clinical presentation and surgical treatment approaches to tongue base schwannoma.

Keywords: base of tongue; neurilemmoma; peripheral nerve sheath tumor; schwannoma; systematic review.

Fig. 1

Systematic search of PubMed returned 293 studies. After review of the titles, abstracts, and full-text, 13 studies were included in the present review.

Fig. 2

Schwannoma of the tongue under low power, with underlying lymphocytic infiltrate and well-defined hypocellular lesion. Reproduced under CC-NC-ND from Badar et al (2016).

Fig. 3

Schwannoma of the tongue is composed of spindled cells with hypocellular and hypercellular regions in addition to focal nuclear-palisading areas (Verocay bodies). Reproduced under CC-NC-ND from Badar et al (2016).

Fig. 4

Sagittal STIR MRI image of the head and neck ( A ) reveals a well-defined hyperintense mass (red arrow) within the base of the tongue. A coronal postcontrast fat-saturated image ( B ) shows heterogeneous enhancement of the lesion abutting the right submandibular gland. Reproduced under CC-NC-ND from Badar et al (2016).