Schwannoma presenting in the soft palate of a nine-year-old boy

Clinicians are frequently presented with patients who are concerned about intra-oral swellings. Many of these swellings are common, are easily diagnosed and often the aetiological factor may be traumatic, infectious or neoplastic in nature. However, some are relatively uncommon, including schwannomas. A schwannoma is described as a benign nerve sheath tumour that presents as a solitary, slow growing swelling, originating from the Schwann cells from any myelinated nerve fibre. The tongue has been described as being the most common site of involvement and, very rarely, the soft palate. Importantly, a schwannoma can often be perceived as a more sinister lesion and can present as a difficult diagnostic challenge for the healthcare professional.

A healthy 9-year-old boy was urgently referred to the Paediatric Dental Department at the Charles Clifford Dental Hospital in Sheffield by his General Dental Practitioner with a 3-week history of a non-painful swelling of the soft palate. There was no history of trauma (physical or chemical) and, only recently, the patient reported that the lesion had gradually increased in size and was interfering with eating and swallowing. Past medical history and systemic enquiry reported nothing of note and extra-oral examination was unremarkable. Intra-oral examination revealed a non-carious mixed dentition. Furthermore, a solitary firm swelling was noted, measuring approximately 1 cm in diameter just to the right of the midline at the junction of the hard and soft palate (Figure 1). Closer examination revealed this was well demarcated by an erythematous zone. The overlying mucosa demonstrated slight ulceration with evidence of sloughing.