Facial Nerve Neuroma: Clinical, Diagnostic, and Surgical Features

Abstract

Facial nerve neuromas are uncommon benign tumors. The diversity of tumor locations and their proximity to vital neurovascular structures create a variety of clinical situations, and the management strategy for each case differs. Two cases with tumors located at different sites and associated with different clinical presentations are discussed in terms of diagnosis and management.KEYWORDS: Neuroma, facial nerve, chorda tympani, paralysis Facial nerve neuromas are uncommon benign neoplasms of Schwann cells. They compose only 0.8% of all intrapetrous mass lesions. 1 More than 300 cases have been reported since they were described by Schmidt in 1930. 2 These tumors can arise from any segment of the nerve from the cerebellopontine angle to the extratemporal peripheral portion. 3,4 The diversity of locations involved with the tumor and their proximity to the auditory apparatus can create a variety of clinical situations. 4 Thus, the site of the tumor, its extension, and the way it involves the surrounding structures determine the surgical approach.This article presents two cases of facial nerve neuroma involving different locations and clinical manifestations, focusing on the diagnostic and therapeutic problems encountered. CASE REPORTS Case 1A 38-year-old woman sought treatment for left facial paralysis, dizziness, and hearing loss and tinnitus in her left ear that had been present for about 1 year. Otoscopy revealed an intact tympanic membrane. A reddish mass was seen behind the tympanic mass. Neurological examination revealed total facial paralysis (i.e., House-Brackmann grade VI). Pure-tone audiometry indicated unilateral sensorineural hearing loss in the left ear with airand bone-conduction thresholds elevated to 60 dB hearing loss. The tympanogram was type-B on the left side. The acoustic reflex was absent to acoustic stimuli on the left side. Computerized tomography

Management of Facial Nerve Schwannoma in Patients With Favorable Facial Function

“…Schwannoma is encapsulated tumor, usually attached to the nerve, that pushes axons aside as they grow. Accordingly, schwannomas can be stripped free of the nerve without sacrificing it 8 . However, Valentino et al 9 noted that the neural fascicles were frequently splayed over the tumors, which makes preservation of the nerve difficult.…”

“…Accordingly, schwannomas can be stripped free of the nerve without sacrificing it. 8 However, Valentino et al 9 noted that the neural fascicles were frequently splayed over the tumors, which makes preservation of the nerve difficult. In four of our six cases of facial nerve schwannoma, the tumor could be dissected from the grossly normal facial nerve.…”

Silent intratemporal facial nerve schwannoma associated with Chronic Suppurative Otitis Media: A rare presentation

“…This is the highest incidence when compared to anywhere else in the body. Facial nerve schwannomas are uncommon benign neoplasms and compose only 0.8% of all intrapetrous mass lesions (2) . Around 500 cases have been reported in the literature since they were first described in 1930 (11) .…”

“…Facial nerve neuromas or neurinoma or neurilemomma or schwannoma are uncommon benign tumors. Schmidt first described these in 1930 (2) . These tumors can arise from any segment of the nerve from the cerebellopontine angle to the extratemporal peripheral portion (2) .…”

“…Schmidt first described these in 1930 (2) . These tumors can arise from any segment of the nerve from the cerebellopontine angle to the extratemporal peripheral portion (2) . Facial nerve paresis is the usual presenting feature of a facial neurinoma (4) .…”