Current Diagnostics and management of submandibular space schwannoma: a systematic review

Abstract

Background: Submandibular space schwannomas (SSS) are rare tumors originating from the neural sheath in the submandibular region with varied prognoses.

Objective: The primary objective was to evaluate the current diagnostic and management outcomes of SSS.

Material and methods: PubMed, Embase, Science Direct, and Web of Science were reviewed for articles from inception through January 2025. Fisher's test was used to calculate the difference in outcomes between extraglandular (EG) and intraglandular (IG) subtypes.

Results: A total of 44 studies with 47 patients were included with a mean age (SD) of 42.8 (19.3) years. Hypoglossal nerve (43.3%) and lingual nerve (36.6%) were the primary nerve of origin for SSS, with significantly higher rates of hypoglossal nerve origin in EG-SSS than IG-SSS (p = .008). Sensitivity analysis of preoperative biopsy showed higher sensitivity rates with core biopsy compared to fine-needle aspiration cytology (FNAC) (85.7% vs. 38.7%) in SSS diagnosis. IG schwannomas are more likely to undergo submandibular gland excision (p = .002) than EG schwannoma.

Conclusion: Core biopsy demonstrated superior sensitivity compared to FNAC, establishing it as the preferred diagnostic tool. The hypoglossal nerve was the most identified nerve of origin.

Significance: This review offers a comprehensive insight into the preoperative and perioperative management of SSS subtypes for surgeon decisions.

Keywords: Submandibular tumor; neck swelling; neurilemmoma; schwannoma; submandibular neoplasm; submandibular region.