engleski

Unusal case of facial nerve neuroma and facial reanimation after removal

We present a case of a 38-year-old male with unilateral facial palsy persisting after treating acute otitis media. CASE DESCRIPTION: A 38- year- old male patient was admitted to our department for the treatment of unilateral acute facial palsy. For 10 days he had been treated in another hospital for acute otitis media with parenteral antibiotic therapy but the facial palsy persisted. This was the second time in 5 years he had facial palsy caused by otitis media. The first time it caused a slight sensorineural hearing loss which was still present. Otoscopy showed macerated ear canal and eardrum. Peripheral facial palsy was graded 4/6 on the House- Brackmann scale. Myringotomy was immediately performed, unknown mass was noticed in the middle ear. MSCT and MR imaging suggested cholesteatoma. Tympanoplasty was performed, no cholesteatoma was found, but inflammated mucosa and unknown tissue in projection of the facial nerve. Pathohistological diagnosis was schwannoma. In the next surgical procedure the tumor was removed from the internal auditory canal to the mastoid. Facial reanimation was performed using anastomosis of the distal part of the facial nerve with the masseteric nerve. DISCUSSION: Facial nerve neuromas are uncommon benign neoplasms of Schwann cells. They compose 0.8% of all temporal bone tumors. Depending on the localization, which can be anywhere along its pathway, they can cause different symptoms including facial palsy, dizziness, hearing loss, tinnitus and taste disorder. The most common approaches for reconstruction are direct facial nerve repair with or without grafting, nerve transfer, cross-facial nerve grafting, and muscle transfer. CONCLUSION: Facial nerve neuromas are rare tumors. They can be treated surgically or using gamma knife and are followed-up using MR imaging. Facial nerve reconstruction after removal of the tumor should be performed.

facial reanimation ; facial neuroma

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