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CASE REPORT
Year : 2018  |  Volume : 17  |  Issue : 2  |  Page : 98-99

Facial schwannoma: Case report


1 Department of ENT, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
2 Department of ENT, Etimesgut State Hospital, Ankara, Turkey
3 Department of Pathology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey

Date of Web Publication26-Nov-2018

Correspondence Address:
Assoc Prof. Sedat Aydin
Department of ENT, Cevizli Mahallesi, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Kartal, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJ.MJ_27_18

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  Abstract 

Facial nerve schwannoma is a rare benign tumor of the temporal bone. It might cause hearing loss, facial nerve paresis, or paralyzes. We present a 46-year-old male patient who diagnosed facial nerve schwannoma on the tympanic segment. We have operated the patient through transmastoid approach successfully. On the follow-up, the patient's facial paralyzes are not recovered so upper eyelid implant and canthopexy methods applied.

Keywords: Facial nerve, schwannoma, surgical treatment


How to cite this article:
Aydin S, Demir MG, Basak K, Çakıl T. Facial schwannoma: Case report. Mustansiriya Med J 2018;17:98-9

How to cite this URL:
Aydin S, Demir MG, Basak K, Çakıl T. Facial schwannoma: Case report. Mustansiriya Med J [serial online] 2018 [cited 2018 Dec 15];17:98-9. Available from: http://www.mmjonweb.org/text.asp?2018/17/2/98/246108


  Introduction Top


Facial nerve schwannoma is a rare benign tumor which can be seen on facial nerve. It is difficult to separate from vestibular schwannoma with magnetic resonance imaging (MRI). General somatic sensorial branch and taste branches of the facial nerve are located on geniculate ganglion. Although facial nerve involvement by schwannoma is a rare entity, it might be presented by newly onset facial nerve paresis or paralyzes, conductive type hearing loss due to otitis media or mass effect.[1] We are presenting a facial nerve schwannoma of the tympanic segment which obstructs mastoid segment and causes facial nerve paralyzes, treated through transmastoid surgical excision successfully.


  Case Report Top


A 46-year-old male patient is admitted to the outpatient clinic with a complaint of on-going ear drainage 7 months ago. The patient was prescribed with local antibiotherapy, but otitis media was not healed, so he was operated. During surgery, it was recognized that there was a mass on the middle ear cavity so surgeon took biopsy and decided to finalize the surgery. The pathologic investigation was facial nerve schwannoma, so the patient was referred to our clinic. On physical examination, the patient has house–Brackmann Stage 3 facial paralyzes. After MRI and computed tomography scan investigation, the patient is decided to operate with transmastoid approach [Figure 1] and [Figure 2]. During surgery, we have recognized that facial nerve of tympanic segment is defective. The tumor was arised from this segment and spreaded to mastoid segment. Malleus and incus bones were eroded due to tumor and segment tympany also eroded, but dura was intact. All the tumor was resected successfully. The pathologic investigation also showed the schwannoma [Figure 3]. After surgery, facial nerve paralyzes remained stable, so plastic surgery clinic applied upper eyelid implant and canthopexy.
Figure 1: Computerized tomography shows the mass lesion on the tympanic cavity and mastoid air cells

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Figure 2: Magnetic resonance investigation reveals the mastoiditis and mucosal thickening

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Figure 3: Spindle-shaped epithelial cells of the schwannoma. (Arrows shows the respiratory type epithelial cells) (H and E, ×200)

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  Discussion Top


Facial nerve tumors might be seen any part of the facial nerve but commonly seen on perigeniculate and tympanic segment. In our case, the tumor was detected on the tympanic segment. Most typical symptoms are facial nerve paresis or paralyzes, hearing loss, tinnitus, otorrhea, otalgia, and vestibular symptoms.[2] In our case, both facial paralysis and otorrhea were detected.

Facial nerve schwannoma is the most common tumor of the facial nerve. Saito and Baxter showed in a study that intratemporal schwannoma has a incidence of 0.8% in a 600 temporal bone material.[3] In our case, we have diagnosed the tumor on the tympanic segment.

Facial nerve schwannoma can be treated by microsurgery methods. Facial nerve functions should be supplied by these methods. Treatment methods are wait and observe, fallopian canal decompression, and stereotaxic surgery.[4] In our case, we decided to perform surgery due to facial nerve paralysis and otorrhea. If there is not any facial weakness, the method which preserves the facial function should be used in first response. On the other hand, when the facial nerve paralysis, labyrinthine segment erosion or brainstem compression are detected, the facial nerve might not be preserved during surgery.[5] In our case, we performed the transmastoid approach to excise the facial nerve schwannoma. At the end of the surgery, the facial nerve function is not changed. To supply the eye closure, plastic surgeon performed the canthopexy and upper eyelid implant. On the follow-up, we do not detect any recurrence. We should keep in mind the facial nerve schwannoma in middle ear cholesteatoma cases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kirazli T, Oner K, Bilgen C, Ovül I, Midilli R. Facial nerve neuroma: Clinical, diagnostic, and surgical features. Skull Base 2004;14:115-20.  Back to cited text no. 1
    
2.
O'Donoghue GM, Brackmann DE, House JW, Jackler RK. Neuromas of the facial nerve. Am J Otol 1989;10:49-54.  Back to cited text no. 2
    
3.
Saito H, Baxter A. Undiagnosed intratemporal facial nerve neurilemomas. Arch Otolaryngol 1972;95:415-9.  Back to cited text no. 3
    
4.
Minovi A, Vosschulte R, Hofmann E, Draf W, Bockmühl U. Facial nerve neuroma: Surgical concept and functional results. Skull Base 2004;14:195-200.  Back to cited text no. 4
    
5.
Shirazi MA, Leonetti JP, Marzo SJ, Anderson DE. Surgical management of facial neuromas: Lessons learned. Otol Neurotol 2007;28:958-63.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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