it has been postulated that solitary neurofibroma is hyperplastic hamartomatous malformations rather than a neoplastic disease . neurofibroma is an uncommon benign neoplasm which originates from nerves that is composed of schwann cells , perineural cells and fibroblasts . generally , neurofibromas present as either solitary mass or as part of neurofibromatosis syndrome or von recklinghausen s disease . neurofibroma is considered to be one of the most common neurogenic tumor but an uncommon intraoral neoplasm . its most common site is the skin presenting as multiple fibromata as part of syndrome of neurofibromatosis ( von recklinghausen 's disease ) or poliglandular syndrome multiple endocrine neoplasia ( men ) iii . peak age of presentation is said to be third decade of life ; however , its occurrence between 10 months and 70 years of age has been reported . debilitating or immunocompromising diseases are not known predisposing factors   and sex predilection is contradictory . intra - oral neurofibromas may present as sessile nodule or pedunculated progressive but slow growing lesion . often painless but may be painful due to pressure effects . commonly seen on the tongue , may occur at any site like the palate ( soft or hard ) , cheek mucosa , floor of the mouth   and in the mandible intraosseous location has been described . we present a successfully treated 40-year - old man with symptomatic left - sided solitary isolated soft palatal neurofibroma . a 40-year - old man referred to our clinic from a peripheral hospital with a 2-year history of lump in the throat . about 2 months to presentation , he noticed rapid increase in the size of the lesion and pain . physical examination revealed good oral hygiene , a pedunculated left - sided soft palatal mass 4  5 cm ulcerated on the medial surface , touching the tongue base and faucial pillars on the ipsilateral side but not attached to them . there is no palpable significant cervical lymph nodes ( fig .  1 ) . oropharyngeal mass pre - operative . full blood count , electrolyte , urea and creatinine , urinalysis and chest x - rays were normal . computerized tomographic scan revealed a mass in the oropharynx , non - contrast enhancing , no calcification and no bony involvement . post - operatively there has been sustained clinical improvement ( fig .  2 ) . it is interesting to note that keeping follow - up appointments by patient is usually difficult in this part of the world , especially post - operative cases of benign or slow growing lesions . although our patient is in his 11th month post - operative , we saw him last 2 weeks after surgery ( fig . it may be related to systemic disorders like men or neurofibromatosis syndrome ( von recklinghausen 's disease ) , thus the importance of its accurate diagnosis . in this index case , it is an isolated solitary soft palatal disease not associated with any systemic pathology . total surgical excision in the head and neck region may pose challenge to the surgeon due to infiltrative nature of the disease . occasionally , such procedure may require sacrifice of vital structures leading to significant functional deficit or leave a cosmetic defect which increases the morbidity and mortality of the disease . although intra - lesional excision will reduce morbidity , it is usually associated with recurrence [ 9 , 10 ] . in our patient , we achieved complete excision without loss of function or a defect . alternative to surgery is not readily feasible , for instance radiation therapy is not possible in diffused cases , however , in solitary plexiform type radiotherapy may retard growth and shrink the tumour . our patient presented with symptoms of dysphagia , muffled voice , rapid increase in size of the lesion and associated pain . we achieved complete symptom resolution with surgical excision of the tumor without need for any alternative therapy . oropharyngeal or soft palatal lesions should be excised completely where possible , this may reduce the frequency of surgery if histology confirm lesion to be benign . tracheostomy as an adjunct to surgery is useful in large lesion like in our patient . continuous surveillance is necessary due to the relative risk of malignant transformation infrequently reported in some cases of radiotherapy - treated schwannomas . solitary isolated neurofibromas of the soft palate not associated with neurofibroma syndrome or systemic pathologies are uncommon .
neurofibroma of the soft palate is an unusual tumor and probably only two cases have been reported in english literature previously . 
 solitary isolated neurofibroma of the soft palate not associated with von recklinghausen 's disease is even more infrequent . to the best of our knowledge 
 , this case represents the third reported in english literature . 
 complete surgical excision was achieved after tracheostomy due to envisaged difficulty in intubation . 
 we present a 40-year - old man with an uncommon soft palatal neurogenic tumor .