Solitary neurofibromas are fairly uncommon. When they do occur, however, they are seen in the head and neck region in nearly 50% of all affected patients. Less than 10% of all solitary neurofibromas present intraorally. The most common initial presentation of intraoral neurofibromas is asymptomatic swelling. They may cause pain, although pain is associated with only about 25% of these lesions. Neurofibromas are benign, nonencapsulated neoplasms comprised of schwann cells, perineural cells, and mature collagen. It is believed that these tumors originate from the perineural fibroblast. Neurofibromas are clinically similar to schwannomas (or neurilemmomas), which are also benign peripheral neural sheath neoplasms. Schwannomas are typically encapsulated. Schwannomas are histologically characterized by the presence of Antoni type A and Antoni type B cells. The Antoni type A cells have elongated palisading nuclei which are not characteristic of the Antoni type B cells. Surgical excision is the treatment of choice for both neurofibromas and schwannomas. Recurrence of either is rare, although neurofibroma recurrence is slightly more common, hence the standard practice of including small segments of adjacent nerve with the tumor during neurofibroma enucleation. Multiple neurofibromas may be associated with systemic disease such as neurofibromatosis or von Recklinghausen’s disease. Suggested reading: Polak M, Polak G, Brocheriou C, Vigneul J: Solitary neurofibroma of the mandible: Case report and review of the literature. J Oral Maxillofac Surg 1989; 47:65.
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