Parapharyngeal Schwannoma of the Mandibular Nerve Associated With Auditory Changes.

We present a case of a parapharyngeal schwannoma of the mandibular nerve with intraosseous extension into the mandible. The initial symptoms included decreased auditory acuity, with subsequent magnetic resonance imaging findings suggestive of Eustachian tube obstruction. This represents a rare symptom of schwannomas of the mandibular nerve. Owing to the degree of bony expansion and cortical thinning of the adjacent mandibular ramus, concern existed for a pathologic fracture. Treatment involved complete excision of the lesion using hemimandibulectomy with second stage reconstruction. The patient noted resolution of the preoperative symptoms. No sign of recurrence of the schwannoma was noted at the 2-year mark.

Robotic surgery: a new approach to tumors of the tongue base, oropharynx, and hypopharynx.

Oropharyngeal cancer was traditionally treated with en bloc resection of the tumor via lip-split mandibulotomy approach, often with adjuvant radiation and chemotherapy. In the 1990s, organ-sparing definitive chemoradiation therapy without surgery became the standard of care for oropharyngeal squamous cell carcinoma. Although organ-sparing treatment provided acceptable locoregional disease control with preservation of anatomic organs adjacent to the tumors and less disfiguration from lack of surgical incisions, it often resulted in significant deficits in speech and swallowing. This article reviews a current organ-and-function preserving approach to oropharyngeal carcinoma using the surgical robot.