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A well-demarcated radiolucency in the vicinity of the inferior alveolar nerve and canal should make one think of a benign neoplasm of peripheral nerve sheath origin such as schwannoma or neurofibroma. The age of the patient, the location and the radiolucency are all supportive of this diagnosis. However, the panoramic radiograph alone is not adequate imaging in determining origin from the alveolar canal. The lack of expansion is also not consistent with this neoplasm. The histology is not supportive of this neoplasm.
Schwannoma, also known as neurilemmoma is a benign, encapsulated neoplasm of Schwann cell origin. It is mostly a soft tissue neoplasm that is rare in the mouth. The soft tissue schwannomas are by far more common than the intra-osseous schwannomas. The soft tissue lesions tend to occurs in young and middle aged patients with equal sex distribution. Tongue is the most common location but it can also occur in the lips, buccal mucosa and floor of mouth. The intra-osseous schwannomas are rare but the head and neck area is the most common location for these neoplasms constituting up to 48% of the intra-osseous schwannomas. They are more commonly described in females (2:1) average age of 29. A significant number of these cases occur in children under 12 years of age. They are slow-growing and can expand the jaw. They are by far more common in the posterior mandible and ramus and rarely occur in the maxilla. They can be associated with pain and paresthesia. Histologically both types, the soft and intra-osseous have the same morphology characterized by two patterns: antoni A, the cross section of which gives rise to what is called "verocay bodies," and antoni B, which is loose and resembles neurofibroma. The treatment of choice is conservative surgical excision.