Trigeminal schwannoma exhibiting orofacial pain

Abstract

Schwannomas are benign nerve sheath tumors arising from the Schwann cells. Trigeminal schwannomas account for 1%–8% of all intracranial schwannomas and 0.1%–0.5% of intracranial tumors. Intracranial trigeminal schwannomas are usually diagnosed in the third and fourth decades of life but can present at any age. The symptoms usually present with trigeminal hyperesthesia, facial pain & headache. Detailed medical history needs to be taken in these patients as there is a possibility of trigeminal schwannoma symptoms presenting as pain of odontogenic origin. The following case report provides a case of trigeminal schwannoma presenting as pain of odontogenic origin. A 37-year-old male complained of pain in the upper right quadrant for 1 week. The pain was mild to moderate in intensity and would increase while clenching his teeth. The pain would not relieve on taking over-the-counter analgesics and would aggravate due to anxiety, lack of sleep, or after consuming drinks with caffeine and also foods having a sour taste. Brushing on the upper right quadrant would also cause a tingling sensation on the right side of the face. Intraoral examination and diagnosis involving 12, 13, 14, and 15 did not reveal any odontogenic cause. Medical history revealed a diagnosis of trigeminal schwannoma of the right side a year back. The trigeminal schwannoma was treated with stereotactic radiation 03 months back. Due to this positive finding in the medical history and probable cause for the intraoral pain, the patient was referred back to his neurosurgeon, who prescribed a 7-day course of methylprednisolone; the steroid regimen resulted in complete cessation of his pain.