Not So Benign Bell’s Palsy: Malignant Peripheral Nerve Sheath Tumor of the Facial Nerve Involving the Temporal Bone

Nguyen, Christopher N; Mallepally, Niharika; Tabilona, Jules R; Lu, Lee

doi:10.1007/s11606-020-06463-0

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Patients with PFP secondary to neoplastic etiology have a poor prognosis, with no evidence of improvement with the established therapy [11], as was our case. Most patients have a delay in etiological diagnosis which unfortunately worsens the prognosis [3,5,11].…”

Section: Discussionsupporting

confidence: 47%

Peripheral facial paralysis as the first manifestation of temporal bone metastasis

Figueiredo

2023

J Clin Images Med Case Rep

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Section: Discussionsupporting

confidence: 47%

Peripheral facial paralysis as the first manifestation of temporal bone metastasis

Figueiredo

2023

J Clin Images Med Case Rep

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“…Zandian et al and Hohman et al suggest that Bell's palsy patients with no signs of recovery within 4 months of symptom onset undergo contrast‐enhanced imaging, whereas Quesnel et al recommend waiting at least 6 months for no signs of recovery 9,13,14 . In contrast, some primary care‐based guidelines suggest that patients with gradual symptomatic progression during the first 2–3 weeks after facial palsy onset and lack of significant recovery after 3 months should be imaged, referred, and/or surgically explored 31,39 . Typical cases of Bell's palsy caused by viral neuritis are expected to show signs of symptomatic improvement after 3–4 months.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 13 , 14 In contrast, some primary care-based guidelines suggest that patients with gradual symptomatic progression during the first 2–3 weeks after facial palsy onset and lack of significant recovery after 3 months should be imaged, referred, and/or surgically explored. 31 , 39 Typical cases of Bell’s palsy caused by viral neuritis are expected to show signs of symptomatic improvement after 3–4 months. In cases with no signs of recovery by 4 months, there is a greater possibility of an occult malignancy being the actual etiology of the facial palsy; delaying workup of such cases past this timepoint could only delay potential cancer diagnoses.…”

Section: Discussionmentioning

confidence: 99%

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort

Kalavacherla

Cos

et al. 2023

The Laryngoscope

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ObjectivesWe characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses.MethodsA de‐identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included.ResultsAmong the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001).ConclusionsIn one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3–4 months.Level of Evidence4 Laryngoscope, 2023

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“…A diagnostic problem is differentiation from Bell's palsy [ 8 , 9 ]. Bell's palsy is thought to be the cause of 80% of hemifacial nerve palsies and, in many cases, has an acute onset, and symptoms improve with steroid administration, so routine imaging is not performed.…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Neurolymphomatosis That Extends to Both the Brainstem and Extracranial Regions

Kondoh,

Lee,

Higashino

et al. 2023

Cureus

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A 73-year-old female developed right facial paralysis of House-Brackmann (H-B) grade III and was diagnosed with Bell's palsy. After three months of steroid therapy, she developed progressive hearing loss, and an MRI revealed a tumor in the right internal auditory canal. Within a few months, the right facial nerve palsy recurred, and the patient was treated with Gamma Knife radiosurgery. The tumor in the irradiated region disappeared, but new dysphagia was observed, and a right parotid gland tumor was detected for the first time. Tumors of the right parotid gland and the digastric muscle of the jaw were surgically resected, and a diagnosis of diffuse large B-cell lymphoma was made. The tumor had invaded the cranial nerves and brainstem region, and the patient did not wish to undergo further medical therapy. This was a case of malignant lymphoma that started as facial paralysis and invaded the brainstem, and testing for possible lymphoma at an early stage prior to radiotherapy was desirable.

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Not So Benign Bell’s Palsy: Malignant Peripheral Nerve Sheath Tumor of the Facial Nerve Involving the Temporal Bone

Cited by 7 publications

References 24 publications

Peripheral facial paralysis as the first manifestation of temporal bone metastasis

Peripheral facial paralysis as the first manifestation of temporal bone metastasis

The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort

Facial Nerve Neurolymphomatosis That Extends to Both the Brainstem and Extracranial Regions

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