Journal of Prevention and Treatment for Stomatological Diseases ›› 2021, Vol. 29 ›› Issue (12): 848-853.doi: 10.12016/j.issn.2096-1456.2021.12.008

• Clinical Study • Previous Articles     Next Articles

Clinical analysis of multi-disciplinary team management in the treatment of giant neurofibroma in maxillofacial and neck region

LIU Yue1(),ZHANG Yi1,2(),ZHANG Jianguo2,ZHANG Long3,YAO Lan4   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University International Hospital, Beijing 102206, China
    2. Department of Oral and Maxillofacial Surgery, Peking University School And Hospital Of Stomatology, Beijing 100081, China
    3. Department of Interventional Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
    4. Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
  • Received:2021-03-29 Revised:2021-06-01 Online:2021-12-20 Published:2021-08-17
  • Contact: Yi ZHANG E-mail:liuyue@pkuih.edu.cn;zhangyi2000@263.com

Abstract:

Objective To investigate the multi-disciplinary team (MDT) management in the treatment of giant neurofibroma in maxillofacial and neck region, to provide reference for clinical practice. Methods Retrospective analysis was conducted on the perioperative whole-process management process of 2 cases of giant neurofibroma in maxillofacial and neck region jointly formulated treatment plan by oral and maxillofacial surgery department with the assistance of the department of anesthesiology, ICU, vascular surgery, thoracic surgery, etc. Results MDT treatment process (anesthesia-embolization-collaborative surgery-ICU-post-operative management) of the two patients was smoothly conducted according to the pre-operative plan. There were no adverse events or accidents that were not predicted by the risk assessment from multiple teams during the operation, and no serious complications occurred after the operation. The post-operative pathological report of both cases was "neurofibroma". Wounds in both patients healed in stage I. The course of treatment was smooth, and the surgical treatment was completed without serious complications. Conclusion MDT management can play a positive role in the diagnosis and treatment of giant maxillofacial and neck neurofibroma so that patients can obtain safer and more effective diagnosis and treatment.

Key words: maxillofacial and neck region, neurofibroma, multi-disciplinary team, anesthesia, arterial monitoring, venous monitoring, digital subtraction angiography

CLC Number: 

  • R78

Figure 1

Giant neurofibroma in maxillofacial and neck region (case 1) a: left neck mass; b: preoperative CT showed that the tumor size was approximately 13 cm ×11 cm × 17 cm, the upper boundary was near the skull base, the lower boundary extended to the chest through the left supraclavicular fossa, and the inner boundary was near the cervical spine; c: preoperative digital subtraction angiography showed abundant blood circulation in the tumor with bulb-holding sign"

Figure 2

Giant neurofibroma in maxillofacial and neck region (case 2) a: facial appearance of the left neck mass; b: preoperative CT showed that the tumor was approximately 8 cm × 7 cm × 11 cm in size, with cystic solid interior, low-density liquefaction zone, which extended medially to the parapharynx, tracheal compression and right-side displacement, and the common carotid artery was surrounded; c: preoperative digital subtraction angiography showed abundant blood circulation in the tumor with a bulb-holding sign"

Figure 3

Preoperative angiography and post-embolization images of patient with giant neurofibroma in maxillofacial and neck region (case 1) a: angiography showed that the tumor had abundant blood circulation and was spherical in shape; b: after the supplying artery was selected and embolized with gelatin sponge particles and spring coil, angiography showed that the blood flow stagnated"

Figure 4

Surgical situation of patient with giant neurofibroma in maxillofacial and neck region (case 1) a: intraoperative field was clear and the tumor tissue was removed; b: the tumor was solid"

Figure 5

Surgical situation of patient with giant neurofibroma in maxillofacial and neck region (case 2) a: the tumor eroded the cervical sheath (as the arrow indicated), and the tumor was removed in sections; b: a small amount of tumor tissue remained on the wall of common carotid artery and internal carotid artery and skull base"

Figure 6

Images of patients with giant neurofibroma in maxillofacial and neck region 2 weeks after surgery (case 1 & case 2) a: case 1; b: case 2; the wounds of 2 patients were all healed at first stage"

[1] Tsang SH, Sharma T. Neurofibromatosis[J]. Adv Exp Med Biol, 2018, 1085:209-211. doi: 10.1007/978-3-319-95046-4_44.
[2] Mukherji MM. Giant neurofibroma of the head and neck[J]. Plast Reconstr Surg, 1974, 53(2):184-189. doi: 10.1097/00006534-197402000-00010.
pmid: 4812027
[3] Ronsley R, Hounjet CD, Cheng S, et al. Trametinib therapy for children with neurofibromatosis type 1 and life-threatening plexiform neurofibroma or treatment-refractory low-grade glioma[J]. Cancer Med, 2021, 10(11):3556-3564. doi: 10.1002/cam4.3910.
doi: 10.1002/cam4.v10.11
[4] Bingham HG. Plexiform neurofibroma of the head and neck[J]. Am J Surg, 1979, 138(4):517-520. doi: 10.1016/0002-9610(79)90411-2.
doi: 10.1016/0002-9610(79)90411-2
[5] 李艳珍, 刘雨薇, 王生才, 等. 儿童头颈部神经源性肿瘤临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(10):983-986. doi: 10.13201/j.issn.1001-1781.2019.10.020.
Li YZ, Liu YW, Wang SC, et al. Clinical analysis of head and neck neurogenic tumor in childhood[J]. Lin Chung Er Bi Yan HouTou Jing Wai Ke Za Zhi, 2019, 33(10):983-986. doi: 10.13201/j.issn.1001-1781.2019.10.020.
[6] Nallanchakrava S, Mallela MK, Jeenepalli V, et al. A rare case report of neurofibromatosis type 1 in a 12-year-old child: a 15-month follow-up[J]. J Oral Maxillofac Pathol, 2020, 24(Suppl 1):S106-S109. doi: 10.4103/jomfp.JOMFP_35_20.
[7] Touzé R, Manassero A, Bremond-Gignac D, et al. Long-term follow-up of choroidal abnormalities in children with neurofibromatosis type 1[J]. Clin Exp Ophthalmol, 2021. doi: 10.1111/ceo.13936.
[8] De Oliveira RL, Fontenele RC, Devito KL, et al. Evaluation of the dimensions, morphology, and position of the mandibular condyles in individuals with neurofibromatosis 1: a case-control study[J]. Clin Oral Investig, 2021. doi: 10.1007/s00784-021-03985-7.
[9] Tam LT, Ng NN, Mckenna ES, et al. Effects of age on white matter microstructure in children with neurofibromatosis type 1[J]. J Child Neurol, 2021: 8830738211008736. doi: 10.1177/08830738211008736.
[10] Dhaenens BE, Ferner RE, Bakker A, et al. Identifying challenges in neurofibromatosis: a modified Delphi procedure[J]. Eur J Hum Genet, 2021. doi: 10.1038/s41431-021-00892-z.
[11] Bethany C, Kenneth C. Neurofibroma of the hard palate[J]. BMJ Case Rep, 2021, 14:e239887. doi: 10.1136/bcr-2020-239887.
doi: 10.1136/bcr-2020-239887
[12] Valdivia AR, Gandarias C. Neck swelling in a type 1 neurofibromatosis patient[J]. Eur J Vasc Endovasc Surg, 2019, 58:414. doi: 10.1016/j.ejvs.2019.03.015.
doi: 10.1016/j.ejvs.2019.03.015
[13] Ahmedou AB, Mohamed AM, Youssef O, et al. A rare cause of cervical swelling: solitary plexiform neurofibroma[J]. Ann Med Surg (Lond), 2021, 64:102225. doi: 10.1016/j.amsu.2021.102225.
doi: 10.1016/j.amsu.2021.102225 pmid: 33786168
[14] Buono FD, Sprong ME, Paul E, et al. The mediating effects of quality of life, depression, and generalized anxiety on perceived barriers to employment success for people diagnosed with neurofibromatosis type 1[J]. Orphanet J Rare Dis, 2021, 16(1):234. doi: 10.1186/s13023-021-01866-6.
doi: 10.1186/s13023-021-01866-6
[15] Ehara Y, Koga M, Imafuku S, et al. Distribution of diffuse plexiform neurofibroma on the body surface in patients with neurofibromatosis 1[J]. J Dermatol, 2020, 47(2):190-192. doi: 10.1111/1346-8138.15194.
doi: 10.1111/jde.v47.2
[16] Boumaza K, Michel G, Salaud C, et al. Peripheral neck nerve tumor: a 73-case study and literature review[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2019, 136(6):455-460. doi: 10.1016/j.anorl.2019.09.005.
doi: S1879-7296(19)30146-2 pmid: 31537489
[17] Waqar-Uddin W, Ahmad F, Khawar A. Recurrent neurofibroma in the head and neck[J]. J Coll Physicians Surg Pak, 2007, 17(10):629-631. doi: 10.2007/JCPSP.629631.
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