Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

HEAD AND NECK
Year
: 2005  |  Volume : 15  |  Issue : 1  |  Page : 47--48

Case report : Neurofibroma of dental pulp" first report from Iran


MM Fani1, SH Shahidi2, B Zamiri3, KH Daneshbod4,  
1 Department of Oral Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Oral and Maxillofacial Radiology,Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address:
S H Shahidi
Assistant Professor of the Dept. of Oral and Maxillofacial Radiology, Faculty of Dentistry, Shiraz Uinversity of Medical Sciences, Shiraz
Iran




How to cite this article:
Fani M M, Shahidi S H, Zamiri B, Daneshbod K H. Case report : Neurofibroma of dental pulp" first report from Iran.Indian J Radiol Imaging 2005;15:47-48


How to cite this URL:
Fani M M, Shahidi S H, Zamiri B, Daneshbod K H. Case report : Neurofibroma of dental pulp" first report from Iran. Indian J Radiol Imaging [serial online] 2005 [cited 2019 Oct 21 ];15:47-48
Available from: http://www.ijri.org/text.asp?2005/15/1/47/28743


Full Text

 INTRODUCTION



Neurofibromatosis (NF) is a well-documented hereditary condition characterized by multiple cafe'-au-lait spots, neurofibromas, and skeletal changes. It has been classified into two major types: NF-1, a generalized form; and NF-2, a central form [1]. These lesions may occur as solitary tumors, or they may affect many sites in the form of multiple neurofibromatosis [2]. The solitary neurofibromas are rare tumors and are considered as benign, slow growing, and relatively circumscribed but non-encapsulated neoplasms which are usually diagnosed when other features of neurofibromatosis are absent [3].

Neurofibromas of the oral cavity may occur as solitary lesions or as part of an NF-1 type and soft tissue lesions are commonly associated with NF-1 type too [1]. Single oral neurofibromas are often observed during childhood [4] and the tongue represents the most common intraoral site for these tumors [2]. Even the central bony lesions are rare ones, but may be associated with solitary neurofibroma [1]. The mandible appears to be affected most often but the maxilla remains an unusual location for the neoplasm [5].

This report represents the neurofibroma of a dental pulp in a peg lateral tooth in maxilla for the first time in Iran.

 CASE REPORT



A 13-year-old was referred to Radiology Department of Faculty of Dentistry of Shiraz University of Medical Sciences with swelling in her left anterior buccal aspect of maxilla. The patient had noted the swelling as well as an active sinus tract in this region about 5 years ago and the size of swelling had increased during this period. Oral physical examination revealed a painless bony hard swelling in the left anterior buccal aspect of the maxilla and a sinus tract in the area between the teeth no. 32 and 34 too. Tooth no. 32 was a peg lateral one and the left maxillary canine was not visible.

When the teeth adjacent to the swelling site were examined by thermal and electrical stimuli, we observed no response to vitality tests in tooth no. 32. The medical history of the patient showed no contribution with her condition and the results of the laboratory tests were within normal limits. Panoramic (radiographic) evaluation revealed a large cloudy gray mass in dental pulp area in the peg lateral tooth of the left maxilla. Borders in the root of the tooth showed a significant displacement [Figure 1]. A mass in the dental pulp was observed inducing the displacement of the borders of the roots indicating a chronic (expansive) condition started at the time of development of the root. Dilacerations in the root of the first maxillary premolar tooth in the same side confirmed this abnormality. The radiolucent area was detected without any sclerotic border at the apex of the involved tooth. Tracing view of the sinus tract indicated to an infection in periapical region of the left peg lateral tooth with a non vital pulp. The crown of the impacted canine in the same side was close to the radiolucent area and root of tooth no. 34. The clinical impression showed tumoral changes in the pulp tissue. Surgery report: Under local anesthesia, a mucoperiosteal flap was noticed in labial side of the involved tooth. Minimal labial osteotomy was performed and the tooth was removed in one piece. The wound was closed and no attempt was made to perform any reconstruction procedure and healing was completely visible.

Pathology report: Macroscopically, the tooth had a cystic dilation surrounded by a 0.1cm diameter bony rim and contained some soft gray materials [Figure 2]. Microscopically, neurofibrous tissues were seen in tooth with severe infiltration of eosinophils, plasma cells and few histiocytes. Capillary proliferation was also visible and a thin hard calcified bony material was demonstrated in the wall of the affected tissue [Figure 3].

 DISCUSSION



As no reports were available in relation to neurofibroma of dental pulp in Iran, it is considered as the first report. A perineural fibrous thickening within the dental pulp with type -1 NF was reported in 1997 [4], showing an expanded perineural fibrous thickening within the left maxillary lateral incisor, considered a manifestation of NF. A palatal swelling was reported in this case due to a wellcircumscribed, nonencapsulated mass which could be easily separated from the underlying bone. The tooth was not associated with any dental anomaly. Our case is the first report of isolated neurofibroma of the dental pulp.

Acknowledgements: We would like to thank the office of Vice Chancellor for Research of Shiraz University of Medical Sciences for financial support of this case report and Davood Mehrabani, the Center for Development of Clinical Research of Nemazee Hospital for editorial assistance.

References

1Lee L., Yan Y.H., and Pharoah MJ. Radiographic features of the mandible in neurofibromatosis. J Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1996; 81:361-7.
2Toth B.B., Long W.H., and Pleasants J.E. Central pacinian neurofibroma of the maxilla J Oral Surg 1968; 25:817.
3Richards D. Neurofibroma of the oral cavity. Br J Oral Surg 1983; 21:36-43.
4Curtin J.P., and Maccarthy S.W. Perineural fibrous thickening within the dental pulp in type-1 neurofibromatosis. J Oral Surg Oral Med Oral Pathol Oral Radiol Endodont 1997; 84:400-3.
5Sharawy A., and Springer J. Central neurofibroma occuring in the mandible. J Oral Surg 1968; 25:817.