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A novel technique to identify the nerve of origin in head and neck schwannomas

Published online by Cambridge University Press:  18 April 2018

H H Ching ,
A G Spinner ,
N H Reeve  and
R C Wang
H H Ching*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, USA
A G Spinner
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, USA
N H Reeve
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, USA
R C Wang
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, USA
*
Author for correspondence: Dr Harry H Ching, Department of Otolaryngology – Head and Neck Surgery, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Blvd, Suite 490, Las Vegas, NV 89102, USA Fax: +1 702 671 2245 E-mail: harry.ching@unlv.edu
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Abstract

Objective:

Identifying the nerve of origin in head and neck schwannomas is a diagnostic challenge. Surgical management leads to a risk of permanent deficit. Accurate identification of the nerve would improve operative planning and patient counselling.

Methods:

Three patients with head and neck schwannomas underwent a diagnostic procedure hypothesised to identify the nerve of origin. The masses were infiltrated with 1 per cent lidocaine solution, and the patients were observed for neurological deficits.

Results:

All three patients experienced temporary loss of nerve function after lidocaine injection. Facial nerve palsy, voice changes with documented unilateral same-side vocal fold paralysis, and numbness in the distribution of the maxillary nerve (V2), respectively, led to a likely identification of the nerve of origin.

Conclusion:

Injection of lidocaine into a schwannoma is a safe, in-office procedure that produces a temporary nerve deficit, which may enable accurate identification of the nerve of origin of a schwannoma. Identifying the nerve of origin enhances operative planning and patient counselling.

Keywords

HeadNeckSchwannomaNeurilemmoma
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 5 , May 2018 , pp. 452 - 456
Copyright
Copyright © JLO (1984) Limited 2018 

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Footnotes

Presented at the American Academy of Otolaryngology – Head and Neck Surgery Annual Meeting, 18 September 2016, San Diego, California, USA.

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