Submandibular schwannoma: is excision a 'gold standard treatment'?

A 58-year-old man was referred to ear, nose and throat (ENT) with an 8-week history of painless right submandibular swelling with no history of weight loss, dysphagia or difficulty with mastication. On examination, there was enlargement of the right submandibular gland, which was diffuse, nodular and firm; but no calcification of the duct or cervical lymphadenopathy. ENT examination including fibreoptic laryngoscopy was normal. Fine-needle aspiration of the lump was inconclusive. Neck ultrasound scan showed a well-defined 3 cm × 3.8 cm × 4.3 cm heterogeneous mass with significant internal vascularity, anterior to the right submandibular gland. MRI (T2-weighted MRI) revealed a neurogenic tumour or a non-sarcomatous soft tissue lesion. Complete excision of the lump was performed by intracapsular dissection and the specimen was submitted for histology, which confirmed the diagnosis of 'Ancient schwannoma' of the submandibular gland. The management resulted in complete resolution of symptoms with no cranial nerve deficits.