Background:
Facial nerve neuromas are rare benign tumors and compose only 0.8% of all intrapetrous
mass lesions.The diversity of tumor location and their proximity to vital neurovascular
structures create a variety of clinical situations, so management strategy for each case
differs.(1)
Case presentation:
A 30-year-old patient presented with right sided facial paralysis (House Brackmann grade III)
as well as head and neck pain in the ER. There was no hearing loss or vestibular symptoms
reported. After being admitted for an i.v. steroid treatment, an MRI was ordered, revealing
an aggressive tumor of the lateral skull base with jugular infiltration, expanding from the
middle ear to the caudal part of the parotid gland. Surgical treatment involved a dual
approach; initially the intraparotid end of the tumor was exposed, revealing a 2x3,5cm mass
clinically corresponding to a neurinoma, situated on the main branch of the facial nerve.
Upon stimulation, all branches distally to the tumor showed adequate motor response. The
proximal tumor removal was performed via a transmastoid approach. Due to deep
infiltration of the tumor in the body of the facial nerve, following its complete resection, we
decided on a graft, utilizing the masseteric nerve and an interponat of the auricular magnus
nerve. The operation proceeded without complications, the tumor was fully removed and
the patient progressively regained motor function of right side of her face.
Conclusion:
Extensive neuromas of the facial nerve are rare, their excision can lead to permanent loss of
nerve function. By performing a nerve graft utilizing the masseteric and auricularis magnus
nerves we were able to successfully reestablish motor function of the facial nerve.
References:
(1)Kirazli et al. doi:10.1055/s-2004-828707

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