American Association of Plastic Surgeons

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Neurofibroma Of The Mandibular Division Of The Trigeminal Nerve
McKay McKinnon, MD.
LURIE CHILDREN'S HOSPITAL, ST. JOSEPH HOSPITAL, Chicago, IL, USA.

PURPOSE:
This study aims to elucidate the pertinent pathology, pathophysiology and surgical correction of NF tumors of the Mandibular Division of the Fifth Cranial Nerve. Historical instruction promotes non-surgical observation of these tumors in the young patient. This dogma has mainly ensured irreversible morbidity and progressive tumor destruction. A retrospective study of patients with mandibular NF who underwent radical surgical resection and reconstruction was performed.
METHOD:
38 patients who underwent radical resection of mandibular nerve NF were studied. 20 adults and 18 pediatric patients comprised the treated study group. Among those 38 patients were 20 adult and pediatric patients with prior history of non-radical surgery with tumor recurrence who served as a rough cohort. CT, MRI , physical exams and photographs, pre and post-op and surgical outcomes greater than 12 months provided the additional data.
RESULTS:
Three pediatric patients in the radical surgery group demonstrated residual or recurrent tumor, requiring additional surgery. Most adult patients required more than one procedure for reconstruction but did not reveal tumor recurrence after initial surgery. There were no deaths. Two patients had partial, permanent facial nerve palsy.
CONCLUSIONS:
Radical surgery for NF of the mandibular division of the Fifth Cranial Nerve provided superior results to those patients treated with observation or superficial "debulking". The minimal morbidity of radical surgery compared with "debulking" or observation confirms that patients with significant NF plexiform tumors, adults and children, deserve serious consideration of this treatment by experienced surgeons.


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