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Nasal Septal Schwannoma ? A Rare Cause of Unilateral Nasal Obstructions.

Schwannomas also known as Neurilemmomas or Neurinomas or Perineural Fibroblastomas are benign, slow growing, encapsulated tumors originating in the neural crests derived from Schwann cells. First described by Verocay (1908) as Neurinomas and later by Stout (1935) as Neurilemmomas, these tumors arise from the Schwann cells of any myelinated nerve including cranial nerves (except olfactory and optic nerve) , peripheral nerves, sympathetic and parasympathetic nerves [1,2]. They are predominantly found in the head and neck region comprising 25-45% of all Schwannomas [3]. In the head and neck region most frequent site affected is the Internal Accoustic Meatus in the form of Vestibular Schwannoma with other sites being scalp, face, oral cavity, pharynx, larynx, trachea, parotid gland, external auditory canal and middle ear[4,5]. There is no racial and gender predilection and it can occur at any age[6,7]. Sino-nasal Schwannomas are very rare accounting for only less than 4% of all head and neck Schwannomas[8,9]. Ethmoid sinus is the most commonly affected area followed by maxillary sinus, nasal cavity and sphenoid sinus [2,10]. Schwannomas of the nasal septum is exceptionally rare[11,12]. A case of Schwannoma of nasal septum was first described by Bogdasanian and Stout in 1943[11]. Clinically patients usually present with nonspecific nasal symptoms like unilateral nasal obstruction, rhinorrhoea, hyposmia/anosmia, headache and epistaxis[13]. CT scan usually shows hypodense areas in the centre with peripheral rim of contrast enhancement[14]. Histopathology is considered as the most confirmatory diagnostic tool which reveals typical patterns characterized by Antoni A and Antoni B areas[15]. Local recurrence is not reported yet in case of complete excision of benign Schwannoma[16]. Malignant Schwannomas occur in 2% cases. We discuss the clinical presentation and management protocol of a patient diagnosed as benign Schwannoma of nasal septum.

Author(s): S. H. Gawarle, Subhro Ganguly, P. N. Keche, A. R. Buche, S. Bhat, N. A. Davange, R. Ravi,Shri Vasantrao Naik