Primary tumors of the facial nerve misdiagnosed: a case series and review of the literature

Abstract

Conclusion: Unusual primary tumors of the facial nerve should be considered in patients with progressive facial paralysis, especially if this is accompanied by hearing loss or vertigo. Misdiagnosis could increase the difficulties of operation, diminish the chance of facial nerve reconstruction, and increase the likelihood of poor reconstructive outcomes.Objective: This paper was to determine the characteristics of facial nerve primary tumors misdiagnosed as tumor-free conditions many years prior, and to describe appropriate treatments.Methods: The cases of 11 Chinese patients with misdiagnosed primary tumors of the facial nerve were reviewed; every one had been misdiagnosed for more than 8 years. All patients presented with progressive or complete facial paralysis and hearing loss, with or without vertigo. The pre- and post-operative images (including CT scans of the temporal bone) and MRI data were reviewed.Results: All tumors were completely resected using the translabyrinthine or transmastoid approach and were confirmed to be primary tumors of the facial nerve. Facial-hypoglossal nerve anastomosis failed because fibrosis developed at the end of the facial nerve in one patient whom this study sought to manage in two stages. One patient accepted facial-hypoglossal nerve anastomosis of two-stage and patient status improved to House-Brackmann (H-B) grade V from H-B grade VI. The other nine patients chose not to undergo reconstruction.