Authors: Nima Nikafshar¹, Mojde Masoudi²˒³, Siavash Vadaye Kheiri²˒³, Maryam Johari⁴Case Presentation: We present the case of an 80-year-old woman with a painful swelling of the anterior maxilla and hard palate, extending into the nasal floor. She had a medical history of hyponatremia, hypertension, tachycardia, and hypothyroidism. Clinical and radiographic examinations showed a palatal mass with underlying bone erosion and perforation into the nasal cavity. Excisional laser biopsy was performed. Histopathology demonstrated a spindle cell neoplasm with Antoni A and B patterns, Verocay bodies, and nuclear atypia, consistent with ancient schwannoma. Immunohistochemistry was diffusely positive for S100 and SOX10.1. IntroductionSchwannoma (neurilemmoma) is an uncommon benign tumor derived from Schwann cells of the peripheral nervous system. These tumors show a marked predilection for the head and neck region, accounting for 25–45% of cases, yet intraoral involvement is reported in fewer than 12%. Most intraoral schwannomas are located on the tongue or floor of the mouth, whereas occurrence in the hard palate is particularly rare.2. Case PresentationAn 80-year-old woman presented in 2023 with pain in the anterior maxilla and nasal floor. Her medical history included chronic hyponatremia, hypertension, tachycardia, and hypothyroidism.Clinical findings: Extraoral examination revealed swelling of the anterior maxilla and nasal floor (FFollow-up: Neurology consultation and brain CT were obtained given the association between schwannoma and hyponatremia reported in prior studies. At 1-year follow-up, no recurrence was observed (Figure 7).4. DiscussionSchwannomas are generally slow-growing, asymptomatic tumors, most frequently affecting the tongue. Intraosseous and palatal cases are extremely rare. Ancient schwannomas are characterized by long-standing growth with secondary degenerative changes. Although they usually present between the ages of 10–40, this case occurred in an 80-year-old, which is highly unusual.5. ConclusionThis case represents a rare ancient schwannoma of the hard palate,