Schwannoma is a benign nerve tumour that originates from Schwann cells, which cover peripheral nerves. Intraosseous schwannoma of the jaw is rare. Primary schwannoma of the mandible presenting as a periapical radiolucency on a non-vital endodontically treated tooth has rarely been referred to in the English medical literature. A rare case of intraosseous schwannoma is reported in a 23-year-old woman. The patient presented clinically with a painful swelling on the right side of the mandible and with a radiologically ill-defined unilocular periapical lesion around the mesial root of the endodontically treated first molar. Surgical treatment involved complete excision of the lesion with a mesial and distal root resection. Histological and immunohistochemical examination showed that the lesion was a primary intraosseous schwannoma of the mandible. Immunohistochemical examination showed a positive and strong reaction for S-100 protein, characteristic of neural tumours. 1 year following surgery, there were no regional recurrences. Radiographically, mandibular intraosseous schwannoma is difficult to differentiate from bone tumours such as ameloblastoma, myxoma, fibrous dysplasia, neurofibroma, central giant cell lesion or periapical lesion, so it should be included in the list of possible periapical pathoses.
This study suggested that the reduction of pain was more pronounced in the patients with alveolar osteitis whose extraction wounds were subjected to low level laser radiation in comparison to those in which extraction wounds were treated with zinc oxide eugenol paste.
Non-Hodgkin's lymphoma has the propensity to affect non-lymphoid tissue including oral tissue. Primary non-Hodgkin's lymphoma of the mandible mistreated as chronic periodontitis with diffuse enlargement of the mandibular canal and ice-cold numbness is very rarely described in English medical literature. A 57-year-old patient presented with a painful swelling on the left side of the mandible with a clinically chronic periodontitis associated with ice-cold numbness. A panoramic radiograph showed a diffuse uniform enlargement of the mandibular canal. Histological examination showed that the lesion was a primary intraosseous non-Hodgkin's lymphoma of the mandible. Immunohistochemical examination showed a positive reaction for CD20+, Ki-67+. Seven months after chemotherapy the patient was observed for possible life-threatening propagation of the disease. In conclusion, primary (extra-nodal) non-Hodgkin's lymphoma of the mandible usually clinically presents with bone swelling, teeth mobility and neurological disturbance. Radiographic features presenting as diffuse enlargement of the mandibular canal could be considered as non-Hodgkin's lymphoma.
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