Palatal Neurofibroma Associated With Localized Periodontitis

A rare case report of neurofibromatosis type 1 in a 12-year-old child: A 15-month follow-up

Neurofibromatosis type 1 (NF-1) or von Recklinghausen's disease is a rare genetic disorder characterized by the development of multiple noncancerous (benign) tumors of nerves and skin (neurofibromas). Head-and-neck neurofibroma is generally located in the soft tissue. Here, we present a case of a 12-year-old girl with NF-1. The disease started in childhood with the appearance of multiple hyperpigmented skin macules. The girl presents generalized freckling and café au lait spots throughout the body and a diffused swelling measuring about 4 cm × 3 cm, extending from the right maxillary hard palate region to the midpalate. The diagnosis of NF-1 was made according to the presence of two or more diagnostic criteria of the National Institute of Health Consensus Development Conference. No recurrence was observed in a 15-month follow-up after extensive surgical ablation.

Gingival Neurofibroma With Teardrop-Shaped Defects of the Interdental Alveolar Bone: An Unusual Oral Manifestation of Neurofibromatosis Type 1

Gingival enlargement, although frequently encountered in clinical settings, is rarely associated with systemic diseases or syndromes. Among the diverse pathological conditions of neurofibromatosis type 1 (NF-1), minor manifestations in the orofacial region are occasionally overlooked. Herein, the authors present an unusual case of gingival neurofibroma in a patient with NF-1 associated with characteristic osseous defects in the alveolus in the long-term course of 17 years from the first examination.A 5-year-old boy with NF-1 was referred for the evaluation of gingival enlargement in the posterior left maxilla. An incisal biopsy led to the diagnosis of neurofibroma. At 22 years of age, the patient was referred again with a complaint of bleeding and pain in the same region refractory to periodontal therapy. The gingiva and tuberosity were swollen, and the second molar was affected by the tumor. Radiography revealed a low level of the interdental septum beneath the tumor with a relatively intact periodontal cortical bone, exhibiting a teardrop-shaped bone defect. The lesion was completely resected with the periosteum.Gingival neurofibroma in NF-1 may be associated with osseous and dental abnormalities and can be mistaken for periodontitis. Raising awareness of this clinical entity can lead to proper management of the esthetic and functional problems in the oral and maxillofacial region.

An unusual case of multiple intraoral manifestations of neurofibromatosis type 1: case report with literature review

The various oral manifestations of neurofibromatosis in dentulous patients have been documented in literature. Although most of the previous documents have discussed on common findings like a prominent lingual papillae, or solitary overgrowth of gingival soft tissue, this article focuses on a relatively rare occurrence of multiple nodular manifestations of Neurofibromatosis-1 on an edentulous alveolar ridge, tongue, palate and lips of an elderly female patient.

Unusual solitary neurofibroma on the lower lip of a child

Neurofibromas (NF) are benign tumors with involvement of the peripheral nerve, which is not frequently located in the oral cavity, and especially, extraordinary rarity on lower lip of a child. This report describes a case of a NF on lower lip in a 12-year-old Brazilian child. NF consists of a wide variety of cell types, including Schwann cells, perineurial cells, and fibroblasts. Due to cellular heterogeneity, several hypotheses have been proposed to explain the histogenesis of this lesion. One of them, it support an origin of Schwannian, while others emphasize the participation of both Schwann cells and perineural cells. Excisional biopsy was performed to establish definitive diagnosis. Microscopically, the lesion was composed of interlacing bundles of elongated cells with wavy nuclei and small nerve fibers. Immunohistopathologic assessment showed cells positive for S-100, confirming the diagnosis of NF. No recurrence was observed after 1-year follow-up. Pediatric dentists must have a thorough knowledge of this unusual lesion.

Solitary oral plexiform neurofibroma: review of literature and report of a case

Plexiform neurofibroma (PN) is a rare, benign tumor of nerve sheath origin, which frequently manifests as part of neurofibromatosis type 1. The article presents a case of solitary PN in a 4-year-old girl, which manifested as a double lip and without systemic or familial involvement. A review of the literature on solitary PN in the oral soft tissue demonstrates the scarcity of such cases.

Oral soft tissue alterations in patients with neurofibromatosis

Our aim was to characterize the type and frequency of oral soft tissue alterations in neurofibromatosis. A total of 103 patients with neurofibromatosis 1 (NF1) and three patients with neurofibromatosis 2 (NF2) were clinically evaluated for their oral soft tissue alterations. Disturbing growths were removed from nine patients with NF1 and from one patient with NF2. The specimens were analyzed using routine histological methods and with immunohistochemistry using antibodies to S100, type IV collagen, CD34, neurofilament, and neuron-specific tubulin (TUBB3). Alterations including oral tumors, overgrowths of gingival soft tissue, and enlarged papillae of the tongue were discovered in 74% of NF1 patients. The results showed that three tumors clinically classified as plexiform neurofibromas and five out of six discrete mucosal tumors displayed histology and immunohistology consistent with that of neurofibroma. The histology of one palatal lesion resembled that of a scar, and the lesion removed from the patient with NF2 was classified as an amyloid tumor. To conclude, oral soft tissue growths are common findings in NF1, but most lesions do not require treatment and the patients may even not be aware of these alterations. Collagen IV, S100, and CD34 are useful biomarkers in the analysis of NF1-related oral soft tissue tumors. The clinicians should recognize that oral soft tissue alterations are relatively common in NF1. Some of the growths are disturbing, and plexiform neurofibromas may bear a risk of malignant transformation.