A rare solitary intraosseous neurofibroma of the inferior alveolar nerve of the mandible: a reappraisal study with a case report of unilateral anterior loop enlargement
Wichai Jindadumrongwech
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi UniversityThongnard Kumchai
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi UniversityRachai Juengsomjit
Department of Oral Pathology, Faculty of Dentistry, Mahidol universitySuttatip Kamolmatyakul
Department of Pediatric Dentistry, Faculty of Dentistry, Bangkokthonburi UniversitySuwadee Kositbowornchai
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Bangkokthonburi UniversityKeywords :
solitary, neurofibroma, mandibular, inferior alveolar nerve, anterior loop enlargement
Abstract :
Enlargement of the anterior loop of the inferior alveolar canal (IAC) on radiographs may
imply normal variation or various pathologies. This finding should be considered with skillful clinical
judgment and cone-beam computed tomography (CBCT) in suspicious lesions is beneficial diagnosis
and treatment. A 59-year-old woman was referred to our clinic for investigation and management
of an accidental finding, clinically asymptomatic, unilateral anterior loop enlargement of IAC in a
radiograph during the dental implant planning process. The patient was clinically diagnosed with
a benign tumor of the mandible. This lesion was a neurofibroma of the mandible in biopsy. The
histopathology and the immunohistochemical staining with S100 protein and mast cells tryptase
confirmed the presence of Schwann cells and mast cells, the characteristic component cells of
neurofibroma. With the good prognosis for total enucleation of this well-circumscribed mass, no
recurrence for 12 months follow-up was found. For discussion, neurofibromas, benign tumors of
neurogenic origin, mostly occur within soft tissue and are associated with neurofibromatosis. Clinical-
ly, a solitary neurofibroma is diagnosed, without other sign of neurofibromatosis. The solitary intra-
osseous neurofibromas of the mandible are rare and our case report is the 38th reported case.
Despite the fairly good prognosis in most cases, an early diagnosis and treatment are difficult to
achieve. Due to the nonspecific clinical manifestations, the differential diagnosis of some pathologies
occurring in the inferior alveolar canal was also discussed.
References :
Marocchio LS, Oliveira DT, Pereira MC, Soares CT, Fleury RN. Sporadic and multiple
neurofibromas in the head and neck region: a retrospective study of 33 years. Clin Oral
Investig. 2007;11:165-9.
Bruce KW. Solitary neurofibroma (neurilemmoma, schwannoma) of the oral cavity.
Oral Surg Oral Med Oral Pathol.
1954;7:1150-9.
Gosavi SR, Jain RS, Datarkar A. Prevalence of oral neurofibroma in Central Indian population:
a retrospective study of 20 years. J Oral Maxillofac Pathol. 2021;25:25-30.
Mortazavi H, Baharvand M, Safi Y, Dalaie K, Behnaz M, Safari F. Common conditions associated
with mandibular canal widening: a literature review. Imaging Sci Dent. 2019;49:87-95.
Neville BW, Damm DD, Allen CM, Chi AC. Oral & maxillofacial pathology. 4th ed. Missouri:
WB Saunders, Elsevier; 2016. p. 494-5.
Zhang Z, Hong X, Wang F, Ye X, Yao YD, Yin Y, et al. Solitary intraosseous neurofibroma in
the mandible mimicking a cystic lesion: a case report and review of literature. World
J Clin Cases. 2023;11:6653-63.
Bernier JL. Differential diagnosis of oral lesions; benign oral tumors. Oral Surg Oral Med Oral Pathol.
1949;2:617-27.
Wright BA, Jackson D. Neural tumors of the oral cavity. A review of the spectrum of benign
and malignant oral tumors of the oral cavity and jaws. Oral Surg Oral Med Oral Pathol. 1980;49:509-22.
Deichler J, Martínez R, Niklander S, Seguel H, Marshall M, Esguep A. Solitary intraosseous
neurofibroma of the mandible. Apropos of a case. Med Oral Patol Oral Cir Bucal. 2011;16:e704-7.
Polak M, Polak G, Brocheriou C, Vigneul J. Solitary neuro fibroma of the mandible:
case report and review of the literature. J Oral Maxillofac Surg. 1989;47:65-8.
da Rosa MR, Ribeiro AL, de Menezes SA, Pinheiro JJ, Alves-Junior SM. Solitary giant neurofibroma
of the mental nerve: a trauma-related lesion? J Craniofac Surg. 2013;24:e247-51.
Tamiolakis P, Chrysomali E, Sklavounou-Andrikopoulou A, Nikitakis NG. Oral neural tumors:
clinicopathologic analysis of 157 cases and review of the literature. J Clin Exp Dent. 2019;11:e721-31.
Mori H, Kakuta S, Yamaguchi A, Nagumo M. Solitary intraosseous neurofibroma of the maxilla: report of a case.
J Oral Maxillofac Surg. 1993;51:688-90.
Sarkar DF, Mishra N, Pati D, Samal SK. Solitary neurofibroma of mandible in a 2-year-old child:
a rare case report and review of literature. J Maxillofac Oral Surg. 2022; 21:1320-5.
Gohel A, Villa A, Sakai O. Benign jaw lesions. Dent Clin North Am. 2016;60:125-41.
Ueda M, Suzuki H, Kaneda T. Solitary intraosseous neurofibroma of the mandible: report of a case.
Nagoya J Med Sci. 1993;55:97-101.
