Abstract
Background: Schwannomas are benign and slow growing tumors that arise from the Schwann cells which ensheath the axons of peripheral nerve, cranial nerve and autonomic nervous system. A schwannoma of facial nerve may originate from extra or intra cranial segments of the nerve. Most of the facial nerve schwannomas originate from intra-tympanic region. In decreasing order of their frequency, schwannomas were found along the tympanic, mastoid (vertical), labrynthine and meatal segments of the facial nerve. It is an extremely rare entity as malignant degeneration of schwannomas is not frequent. A high level of clinical suspicion with detailed neuro-otological and radiological studies play important role in preoperative diagnosis of schwannomas. Case presentation: We reported a case of 35-year-old male with progressive right sided facial asymmetry, sudden onset hearing loss and non-pulsatile tinnitus in right ear. The patient’s presentation and diagnostic examinations helped us to reach a provisional diagnosis though final diagnosis was done on the basis of histopathological examination of the excised tumor which was suggestive of facial nerve schwannoma. Conclusion: The rare and inconsistent clinical presentation and radiological pattern of facial schwannoma often leads to a delayed and indefinite diagnosis. The critical step in management of diverse lesion is diagnosis for the management of facial schwannoma. This report is about a challenging case of facial nerve schwannoma in intra-tympanic region which was diagnosed and managed in our institution.
Highlights
Virchow first reported schwannoma in 1908, a tumor arising from the neural sheath of the peripheral sensory, motor, sympathetic, and cranial nerves
Schwannoma is an ectodermal, benign, encapsulated and solitary tumor that originates from Schwann cells of peripheral nerve sheath [1]
Lack of epineurium leads to effacement of facial nerve and spreading of individual fascicles over the surface of large facial schwannoma
Summary
Virchow first reported schwannoma in 1908, a tumor arising from the neural sheath of the peripheral sensory, motor, sympathetic, and cranial nerves. Schwannoma is an ectodermal, benign, encapsulated and solitary tumor that originates from Schwann cells of peripheral nerve sheath [1]. They have a tendency to push axons of nerve of origin away [2] and so that they can potentially be resected with nerve preservation. A 35-year-old man presented to our hospital with complaints of progressive right facial weakness and intermittent twitching of the right eyelid accompanied by hearing loss, tinnitus and sensation of fullness in right ear for 1 month He had no previous history of facial nerve surgery or head trauma. Preoperative magnetic resonance imaging (MRI) showed soft tissue lesion along tympanic and mastoid segments of right facial nerve, widening bony canal and bulging out through stylo-mastoid foramen (Figure 1).
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