IJCRR - Vol 07 Issue 12, June, 2015
A CASE REPORT OF FACIAL NERVE SCHWANNOMA CO-EXISTING WITH AN EXTERNAL AUDITORY CANAL OSTEOMA: PRESENTATION OF UNILATERAL FACIAL ASYMMETRY WITH CONDUCTIVE HEARING LOSS
Author: Kriti Bhujel
Aim: We present here a case of facial schwannoma co-existent with an external auditory canal osteoma which presented with a history of unilateral facial asymmetry with conductive hearing loss.
Case Report: A 50 year old female presented with progressive unilateral facial asymmetry of the left side since 5 years, with gradually progressive hearing loss in the left ear since 2 months. Examination revealed left-sided unilateral lower motor neuron facial palsy and a whitish bony hard mass in the left external auditory canal. CECT and CEMR scan of temporal bone showed a neoplasm arising from the vertical segment of left facial nerve. Modified radical mastoidectomy was done to trace the facial nerve lesion along the vertical segment of the facial nerve in the temporal bone and the exploration was extended along its extratemporal segment. The neoplasm was excised and histopathology examination revealed facial nerve schwannoma. The bony mass in the external auditory canal was excised and histopathological examination confirmed it to be an osteoma.
Conclusion: The gradually progressive unilateral facial asymmetry was due to the facial nerve schwannoma, while the unilateral conductive hearing loss was explained by the presence of the osteoma in the external auditory canal. The patient was cleared of the disease and physiotherapy was started. The asymmetry of the face improved from House-Brackmann grade 5 to 4 within a month. The hearing threshold improved to within the normal hearing range. The patient has been followed up for 6 months and there is no recurrence of symptoms.
Keywords: Facial asymmetry, Conductive hearing loss, Facial nerve schwannoma, Osteoma, House-Brackmann staging
Kriti Bhujel. A CASE REPORT OF FACIAL NERVE SCHWANNOMA CO-EXISTING WITH AN EXTERNAL AUDITORY CANAL OSTEOMA: PRESENTATION OF UNILATERAL FACIAL ASYMMETRY WITH CONDUCTIVE HEARING LOSS International Journal of Current Research and Review. Vol 07 Issue 12, June, 19-23
1. Moffat DA, Ballagh RH. Rare tumors of the cerebellopontine angle. Clinical Oncology (Royal College of Radiologists (Great Britain). 1995; 7: 28-41.
2. Bonneville F, Sarrazin JL, Marsot-Dupuch K, Iffenecker C, Cordoliani YS, Doyon W et al. Unusual lesions of the cerebellopontine angle: A segmental approach. Radiographics. 2001; 21: 419-38.
3. Lalwani AK. Meningiomas, epidermoids, and other nonacoustic tumors of the cerebellopontine angle. Otolaryngologic Clinics of North America. 1992; 25: 707-28.
4. Bartels U, Arrington JR. Rare Tumors of the cerebellopontine angle. In: Jackler RK, Brackmann D (eds). Neurotology. St Louis: Mosby, 1994: 835-61.
5. Maran AGD. Benign diseases of the neck. In: Kerr AG (ed.). Scott-Brown’s otolaryngology, 6th edn. London: Butterworth Heinemann, 1997: 5/16/8-10.
6. Hajjaj M, Linthicum FH. Facial nerve schwannoma: Nerve fibre dissemination. Journal of Laryngology and Otology. 1996; 110: 632-3.
7. Kertesz TR, Shelton C, Wiggins RH, Salzman KL,Glastonbury CM, Harnsberger R. Intratemporal facial nerve neuroma: Anatomical location and radiological features. Laryngoscope. 2001; 111: 1250-6.
8. King TI, Morrison AW. Primary facial nerve tumors within the skull. Journal of Neurosurgery. 1990; 72: 1-8.
9. Marzo, Sam J; Zender, Chad A; Leonetti, John P. Facial nerve schwannoma. Current opinion in otolaryngology and Head and Neck Surgery.2009 ;17: 5:346-50
10. Denia A, Perez F, Canalis RR, Graham MD. Extracanalicular osteomas of the temporal bone. Arch Otolaryngol Head Neck Surg 1979; 105: 706-9.
11. Camacho RR, Vicente J, Cajal SR. Imaging quiz case 2. Arch Otolaryngol Head Neck Surg 1999: 125: 349, 351-52.
12. Sheehy JL. Diffuse exostoses and osteomata of the external auditory canal: A report of 100 operations. Otolaryngology, Head and Neck Surgery. 1982; 90: 337-42.