Sinonasal Schwannoma in a Six-Year-Old: An Unusual Presentation

摘要

Schwannomas commonly occur in the head and neck region and extremities, but nasal schwannoma is extremely rare. It accounts for less than 4% of benign solitary schwannomas of the head and neck region. Few cases and very few case series have been reported till date. We report the case of a six-year-old female who presented with mouth breathing of two years with persistent and progressive right nasal obstruction of three months. There was recurrent watery ipsilateral nasal discharge, but no epistaxis, no otologic or throat symptoms, no headaches, facial pain, proptosis or visual loss, no facial hypoesthesia, fever or weight loss. She also had right sided epiphora. She had used topical steroid and decongestant without improvement. Ten months prior to presentation, she had right dacrocystorhinostomy. Examination revealed mucosa mass completely filling the right nasal cavity with an ipsilateral deviation of nasal septum—it was painless with no contact bleeds. Nasal patency was clinically absent bilaterally. Computed tomogram revealed expansile isodense soft tissue mass in the right nasal cavity with heterogeneous enhancement on contrast administration which measured 2.5 cm by 3.7 cm by 5.2 cm. She had an intranasal excision of the tumour and histology revealed Antoni A and B patterns, which is diagnostic of schwannoma. She was fully relieved of symptoms after surgery. Conclusion: Solitary nasal schwannoma is rare especially in childhood. There are various causes of epiphora; definitive investigation of the cause in the index case was not established before dacrocystorhinostomy. Thorough nasal evaluation of epiphora or related ocular symptoms should be sought before definitive procedures.