Facial Nerve Neurinoma with Crocodile Tear Syndrome

Abstract

A case of neurinoma originating from the horizontal portion of the facial nerve is reported. The patient was a 29-year-old male complaining of tinnitus, facial palsy, hearing loss, and crocodile tear syndrome on the left side. Neurological examination on admission revealed peripheral type facial palsy on the left, hyposalivation of the left submandibular gland, diminished sense of taste on the anterior two thirds of the tongue on the left side, and loss of the stapedial reflex on the left. Schirmer's lacrimation test showed crocodile tear and slight decrease in lacrimation on the left. A hearing test revealed a slight hearing loss of the conductive type on the left. Plain films of the skull and tomograms of the temporal bone revealed destruction of the petrosal bone in the semicircular canal and the attic on the left. Computed tomography scan showed a mass in the left middle cranial fossa which was enhanced homogeneously after infusion of the contrast medium. Surgery was performed and the tumor was removed by the middle cranial fossa extradural approach. The tumor originated from the horizontal portion of the facial nerve, extending to occupy the geniculate portion and the attic. Histological diagnosis was typical neurinoma. The authors discuss the interesting clinical findings of facial nerve neurinoma with a review of the literature.