Salivary Gland Choristoma of the Middle Ear and Review of the Literature

Abstract

Conductive hearing loss due to middle ear masses is uncommon and usually diagnosed after biopsy. We present a case of a permanent facial palsy occurred following an uneventful biopsy during an exploratory tympanotomy in a salivary gland choristoma of the middle ear. Most salivary gland choristomas have been found in the head and neck. Its location in the ear is extremely rare, and thus we present the 38th case in English and non-English literature from the first publication by Taylor in 1961. Complete surgical removal of salivary gland choristomas of the middle ear is indicated when may not result in permanent damage to the facial nerve. Only biopsy and observation are recommended when the mass is intimately associated with the facial nerve or there are unsafe facial nerve abnormalities. Although the facial nerve is involved in 40% of cases, transient or even permanent facial palsies are exceptional. The reactivation of latent herpes virus in the facial canal may be involved in facial palsy' etiology following minimal and uneventful middle ear surgery like a biopsy rather than nerve injury related to facial canal malformations.

Salivary Gland Choristoma of the Middle Ear in a Child: A Case Report

“…11 Many authors have stated that complete removal of the choristoma is not necessary and the risk of malignancy is very low. 10,12 In case of destroying the middle ear ossicles, it is possible to make a reconstruction using a prosthesis (partial or total). 11 Bone-anchored hearing aids can provide a viable alternative to hearing enhancement in other cases, 13 such as the case reported here.…”

“…In our case, it was not possible to remove the tumor completely because of a large bony bridge enclosing the facial nerve and adhering to the promontorium. A conservative strategy (ie, biopsy to diagnose and follow-up; regular checkups, including radiological and audiological methods) is recommended in cases where the choristoma tissue is in intimate relationship with the facial nerve 10 and the risk of injury to the facial nerve is high. 11 Many authors have stated that complete removal of the choristoma is not necessary and the risk of malignancy is very low.…”

“…11 Many authors have stated that complete removal of the choristoma is not necessary and the risk of malignancy is very low. 10,12 In case of destroying the middle ear ossicles, it is possible to make a reconstruction using a…”

Middle Ear Salivary Choristoma: A Rare Case Report and Update on Congenital Associations, Facial Nerve Involvement, and Treatment Strategies

“…Cases involving the facial nerve had a significantly lower complete excision rate than those in which the facial nerve was spared (44.4% vs. 84.2%, p =0.0027, Table 2 ). Permanent facial nerve palsy after removal of a middle ear salivary choristoma has occurred in two reported cases [ 36 , 46 ], with two additional cases of transient facial nerve palsy that later recovered [ 38 , 47 ]. To mitigate this risk of facial nerve palsy in all cases, use of a facial nerve monitor during surgery is strongly recommended [ 4 , 44 ].…”