Intraparotid Facial Nerve Schwannoma Research Articles

Diagnosis and surgical outcomes of intraparotid facial nerve schwannoma showing normal facial nerve function

The findings of intraparotid facial nerve schwannoma (FNS) using preoperative diagnostic tools, including ultrasonography (US)-guided fine needle aspiration biopsy, computed tomography (CT) scan, and magnetic resonance imaging (MRI), were analyzed to determine if there are any useful findings that might suggest the presence of a lesion. Treatment guidelines are suggested. The medical records of 15 patients who were diagnosed with an intraparotid FNS were retrospectively analyzed. US and CT scans provide clinicians with only limited information; gadolinium enhanced T1-weighted images from MRI provide more specific findings. Tumors could be removed successfully with surgical exploration, preserving facial nerve function at the same time. Gadolinium-enhanced T1-weighted MRI showed more characteristic findings for the diagnosis of intraparotid FNS. Intraparotid FNS without facial palsy can be diagnosed with MRI preoperatively, and surgical exploration is a suitable treatment modality which can remove the tumor and preserve facial nerve function.

Intraparotid facial nerve schwannoma: a case report

Background. Our objective is to present a very rare clinical case of intraparotid facial nerve schwannoma that clinically presented as an asymptomatic parotid tumor, mimicking pleomorphic adenoma, and was diagnosed only intraoperatively. Another purpose is to discuss diagnostic possibilities, appropriate planning for the management and predictive outcomes of surgical management. Materials and methods. A clinical case of a patient with an asymptomatic parotid mass diagnosed as a facial nerve schwannoma intraoperatively is presented. The patient’s presentation and the diagnostic procedures, surgery and the follow up procedures are discussed. A review of literature is presented. Conclusions. Intraparotid facial nerve schwannoma is an extremely rare entity and rarely diagnosed preoperatively. Management of intraparotid facial nerve schwannomas (IFNS) is very challenging because the diagnosis is often made intraoperatively and in most cases resection can lead to severe facial nerve (FN) paralysis with significant aesthetic consequences. Imaging studies and fine-needle aspiration cytology are not always helpful in preoperative diagnosis.

Intra-parotid facial nerve schwannoma with intra-temporal extension; a case report. Is there a role for stereotactic radiotherapy?

Facial nerve schwannoma (FNS) is an extremely rare benign tumour that may arise anywhere along the course of the facial nerve; the standard treatment is total removal via microsurgery. Stereotactic radiotherapy has been shown to be effective in the treatment of skull base tumours, in particular for acoustic neuromas; it is interesting to notice that also the few data existing in literature about the use of radiotherapy for non acoustic schwannomas show an excellent local control rate and few adverse effects. Here we report a case of facial nerve neuroma, involving the nerve sheath from the geniculate ganglion to the parotid gland, treated with fractionated stereotactic radiotherapy after debulking surgery.

Management options for intraparotid facial nerve schwannoma

Conclusion: Limited intraparotid facial nerve schwannoma (IFNS) and IFNS with intratemporal involvement should be managed separately because of their different characteristics. Limited IFNS with House–Brackman (HB) grade ≤ II should undergo tumor removal only if it can be resected easily off the nerve. For IFNS with intratemporal involvement and a HB grade ≤ II, a conservative treatment (i.e. wait-and-see alone, or bone decompression) is recommended. Objective: To provide management options for IFNS. Methods: From 1996 to 2011, seven cases of IFNS underwent surgical treatment. Clinical and radiologic findings, surgical approach, and preoperative and postoperative facial nerve function were analyzed retrospectively. Results: Three IFNSs extended into the mastoid (43%). Two of the three patients with mastoid extension progressed to HB grade IV after the operation because the facial nerve was sacrificed, whereas the other one who underwent biopsy and decompression remained at HB grade II. Four limited IFNSs (57%) presented with grades I–II, three of which were removed while preserving facial nerve function and the other was removed by cystic decompression. No recurrence or significant growth of the non-resected schwannoma was observed.

Intraparotid Facial Nerve Schwannoma with Temporal Bone Extension

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment.Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: OneResults: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy withfacial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved.Conclusion: A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.Keywords: intraparotid facial nerve schwannoma, facial nerve paralysis, parotid mass

The intraparotid facial nerve schwannoma: a diagnostic and management conundrum

ObjectivesThe aims of the study were (1) to review the management strategy and clinical outcomes of all intraparotid facial nerve (FN) schwannomas (PFNSs) treated at a single tertiary academic center from 1975 to 2010 and (2) to summarize all previously reported cases of PFNS in the international literature. Study designA retrospective cohort study and literature review. MethodsFifteen patients were diagnosed and treated at the authors' institution from 1975 to 2010. In addition, 124 published cases were systematically reviewed. ResultsThe most common presentation of PFNS was a painless parotid mass with normal FN function. Eccentric, loosely attached intraparotid tumors underwent gross total resection with nerve preservation granting satisfactory postoperative FN function, whereas “inseparable” intraparotid tumors were observed in 8 cases with stable long-term size. Lesions that extended into the fallopian canal underwent complete resection with FN sacrifice and nerve grafting in 10 cases, whereas 1 patient received subtotal resection of the intraparotid portion with stereotactic radiotherapy targeting the intratemporal component. ConclusionsIntraparotid FN schwannomas present similar to other primary salivary gland neoplasms, making an early diagnosis challenging. Intraoperative recognition of gross tumor characteristics and early histologic diagnosis with strategic biopsy are critical. Information including tumor location and extent, preoperative FN function, and the gross relationship between the tumor and the FN may guide the surgeon toward an optimal treatment plan emphasizing long-term neurologic preservation.

Two Cases of Intraparotid Facial Nerve Schwannoma

Intraparotid facial nerve schwannomas are rare, their preoperative diagnosis is difficult, and there are controversies about how to proceed when they are suspected intraoperatively. We present two cases of intraparotid facial nerve schwannoma that were diagnosed during parotid surgery, and describe the procedure and follow-up performed.

被膜内摘出術を行った耳下腺内顔面神経鞘腫例

Intraparotid facial nerve schwannoma, an uncommon tumor documented sporadically in medical literature, must be differentiated from pleomorphic adenoma. Function-preserving surgical resection is also important. We report a case of intraparotid facial nerve schwannoma in a 42 year-old woman seen for a right parotid gland tumor 28 mm in diameter. Computed tomography (CT) and Magnetic resonance imaging (MRI) showed a noninvasive round mass between the tip of the mastoid process and the mandibular condyloid process. Fine-needle aspiration cytology confirmed a benign mass consisting of histiocytes or interstitial cells, although preoperative tests could not differentiate schwannoma from pleomorphic adenoma. Surgical exploration found a yellow encapsulated mass arising in the main facial nerve trunk and the nerve funiculus extending into the capsule. A surgeon diagnosed a facial neurogenic tumor, which was resected intracapsularly leaving no tumor tissue in surgical microscopy. Postoperative facial palsy eventually disappeared, completely restoring facial nerve function. No recurrence has been seen in the 7 years and 8 months since surgery, indicating that intracapsular resection may be an intraparotid schwannoma treatment providing a favorable prognosis.

Intraparotid facial nerve schwannoma: management decision based on facial nerve function. The Mayo Clinic Experience

The LaryngoscopeVolume 121, Issue S5 p. S279-S279 Triological Society's 2011 Annual Meeting Intraparotid facial nerve schwannoma: management decision based on facial nerve function. The Mayo Clinic Experience Brian C Gross M.D., Brian C Gross M.D. Department of Otorhinolaryngology - Head and Neck Surgery Mayo Clinic Rochester MNSearch for more papers by this authorKerry D. Olsen M.D., Kerry D. Olsen M.D. Department of Otorhinolaryngology - Head and Neck Surgery Mayo Clinic Rochester MNSearch for more papers by this authorEric J. Moore M.D., Eric J. Moore M.D. Department of Otorhinolaryngology - Head and Neck Surgery Mayo Clinic Rochester MNSearch for more papers by this author Brian C Gross M.D., Brian C Gross M.D. Department of Otorhinolaryngology - Head and Neck Surgery Mayo Clinic Rochester MNSearch for more papers by this authorKerry D. Olsen M.D., Kerry D. Olsen M.D. Department of Otorhinolaryngology - Head and Neck Surgery Mayo Clinic Rochester MNSearch for more papers by this authorEric J. Moore M.D., Eric J. Moore M.D. Department of Otorhinolaryngology - Head and Neck Surgery Mayo Clinic Rochester MNSearch for more papers by this author First published: 15 August 2011 https://doi.org/10.1002/lary.22235Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume121, IssueS5Supplement: Poster Presentations from the Triological Society's 2011 Annual Meeting2011Pages S279-S279 RelatedInformation

Dos casos de schwannoma intraparotídeo del nervio facial

Intraparotid facial nerve schwannomas are rare, their preoperative diagnosis is difficult, and there are controversies about how to proceed when they are suspected intraoperatively. We present two cases of intraparotid facial nerve schwannoma that were diagnosed during parotid surgery, and describe the procedure and follow-up performed.

Diagnosis and management of intraparotid facial nerve schwannoma

Our objective was to provide the management guidelines for facial nerve schwannomas (FNSs) presenting as a parotid mass. The study is a case report and literature review. Four clinical cases of patients with an asymptomatic parotid mass diagnosed as FNS are presented. The patient's presentation, the diagnostic algorithm and surgical rationale are discussed. A review of the literature on FNSs is presented. Intraparotid FNSs are an extremely rare entity and are rarely diagnosed preoperatively. Intraoperatively, conservative biopsy in a non-functional part of the lesion can be used to make the diagnosis. Most of the FNSs of patients with normal facial nerve function could be dissected off the nerve trunk without losing FN function. FNS patients with preoperatively abnormal FN function should be managed conservatively or undergo reconstruction with nerve graft after tumour resection.

An Unusual Case of Intraparotid Facial Nerve Schwannoma

An Unusual Case of Intraparotid Facial Nerve Schwannoma

Critical literature review on the management of intraparotid facial nerve schwannoma and proposed decision-making algorithm

Management of intraparotid facial nerve schwannomas (IFNS) is very challenging because the diagnosis is often made intra-operatively and in most cases, resection could lead to severe facial nerve (FN) paralysis, with important aesthetic consequences. Articles in the English language focused on the management of FN schwannoma have been selected and critically reviewed. A decision-making algorithm is proposed. In the case of type A or B neoplasms, or in case of a pre-operative FN House-Brackmann (HB) grade IV or worse, the authors would favor a resection of the IFNS and (where necessary) a reconstruction of the nerve. In the case of pre-operative HB grade III or better and type C or D neoplasms, patients would undergo an intra-operative biopsy to rule out malignancy, and a possible conservative management could be adopted. Localization and adherences of IFNS, as well as pre-operative FN function are important factors that must be considered in the decision-making process for IFNS to optimize the functional outcomes.

Large intraparotid facial nerve schwannoma: Case report and Review of the Literature

Here is reported an extremely rare case of a large intraparotid facial nerve schwannoma in a 32-year-old female who presented with a parotid mass. There had been a long clinical course and sudden onset of facial weakness. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature.

Intraoperative diagnosis of facial nerve schwannoma at parotidectomy

Objective Our objective was to provide a diagnostic algorithm for facial nerve schwannomas presenting as a parotid mass. Study design The study is a case report and literature review. Methods A clinical case of a patient with an asymptomatic parotid mass diagnosed as a facial nerve schwannoma intraoperatively is presented. The patient's presentation and the diagnostic algorithm and surgical rationale are discussed. A review of the literature on facial nerve schwannomas is presented. Conclusions Intraparotid facial nerve schwannomas are an extremely rare entity and are rarely diagnosed preoperatively. Most of these benign lesions can be managed conservatively with the goal of preserving facial nerve function. Intraoperatively, fine-needle aspiration and/or conservative biopsy in a nonstimulating portion of the lesion can be used to make the diagnosis.

Intraparotid facial nerve schwannoma: management options

Intraparotid facial nerve schwannoma (FNS) is a very rare, benign tumour mimicking pleomorphic adenoma. Resection of this slow growing tumour may result in unnecessary facial nerve paralysis. The aim of this study is to present results of facial nerve schwannoma treatment at our institution and proposes a management plan. This is a retrospective case series of four patients, three male and one female with a mean age of 47.7 years who presented with a long-standing, asymptomatic parotid swelling. Two patients had facial weakness and underwent superficial parotidectomy, resection of tumour and facial nerve repair with a free graft from the greater auricular nerve. Two patients underwent biopsy without tumour resection. All tumours were confirmed histologically as facial nerve schwannomas. The mean follow up period was 3.5 years. Patients with resection of facial nerve schwannoma had a postoperative House Brackmann grade III and IV. Patients with biopsy had normal postoperative facial nerve function and the tumour did not grow significantly. No adverse effects or recurrence were reported. There is no preoperative diagnostic modality that can identify facial nerve schwannoma with certainty. Difficulty in locating the facial nerve intraoperatively raises suspicion of a neurogenous tumour of the facial nerve and this may prevent unnecessary damage to the nerve. Not every facial nerve schwannoma should be resected. This decision is based on (a) the extent of tumour (b) preoperative facial nerve function (c) best results achieved with nerve repair and (d) patient's preferences. Large tumours with extension into the mastoid cavity or encroachment of sensitive structures and preoperative facial weakness are indications for surgical intervention. In most other cases, biopsy and observation suffices.

Intraparotid facial nerve schwannoma. What to do?

An intraparotid facial nerve schwannoma is often not recognised in pre-treatment work-up and frequently results in subsequent significant postoperative morbidity. We have evaluated the literature regarding pre-treatment work-up and facial nerve function outcome. Two of our own cases are presented. A minority of the intraparotid schwannomas can be removed by resection while preserving facial nerve integrity and function. In the event of preoperative facial nerve dysfunction, tumour resection and subsequent nerve repair should be considered. If resection of an intraparotid facial nerve schwannoma cannot be performed with preservation of facial nerve integrity and function, a wait-and-see policy seems justified due to the indolent behaviour of the tumour and moderate results of facial nerve reconstruction.

Intraparotid facial nerve schwannoma: literature review and classification proposal

The aim of this review was to assess and describe the pathological characteristics of intraparotid facial nerve schwannoma, in order to facilitate correct prognostic evaluation and appropriate therapeutic decision making. The literature was reviewed regarding involvement of the various portions of the facial nerve. A classification is proposed, based on anatomical and pathological evaluations, which can supply important information on facial functional outcomes. From this study, two important characteristics of facial nerve schwannoma emerged: the schwannoma may be capable of surgical dissection from the facial nerve, leaving the latter anatomically preserved; or it may be tightly bound to the nerve, in which case it must be removed along with a variable section of nerve tract, followed by reconstruction. The extent of the neoplasm and the involvement of different branches of the facial nerve are very important elements to consider when evaluating prognosis and therapy. To emphasise the usefulness of a classification, based on anatomical and pathological evaluation, which can supply information about post-operative facial function.

Intra Parotid Facial Nerve Schwannoma: A Case Report

Schwannoma in the head and neck region is very rare. The tumour occurring in the intraparotid facial nerve is even rarer. A patient presenting with a parotid swelling with facial nerve paralysis is not pathognomonic of a facial nerve schwannoma. However it may occur because enlargement of the parotid, by any kind of tumour especially a malignant one can cause facial nerve paralysis. We report a case of an intraparotid facial nerve schwannoma, in a patient who presented with parotid enlargement and facial nerve paralysis.

Intraparotid facial nerve schwannoma: diagnosis and management

Objective Facial nerve schwannomas are rare neoplasms that present a challenge in diagnosis and management. We sought to gain insight into the clinical presentation and its implications in management. Study design and setting A group of patients diagnosed with schwannoma was reviewed, with focus on tumor arising in the intraparotid region of the facial nerve. The patient population consisted of 3722 patients evaluated retrospectively over 38 years at the Shadyside Facial Paralysis Center, a tertiary referral center. From this population, 29 patients (18 women and 11 men) with the diagnosis of schwannoma were selected for review. Results Twenty-nine patients had facial nerve schwannoma. The average age at diagnosis was 44 years (range, 7 to 78 years). Eight patients had intraparotid involvement, with 5 having a palpable mass in the parotid. The duration of symptoms averaged 8.4 years overall, with intraparotid involvement averaging 10.9 years. The 8 intraparotid schwannomas had a mean House-Brackmann grade of 1.5/6 at initial presentation. Postoperative facial nerve function was only 4.4/6 for resected intraparotid schwannomas. Conclusions Intraparotid facial nerve schwannomas are slow growing tumors, which are usually asymptomatic but can be painful. Schwannoma should be suspected if the facial nerve cannot be found intraoperatively or if the tumor is intimately associated with the facial nerve. In cases where schwannoma is suspected, biopsy is recommended, while complete resection is postponed to obtain imaging studies to evaluate the extent of disease and to discuss possible outcomes with the patient. Significance This article provides guidance for the appropriate management of intraparotid facial nerve schwannoma.