Facial nerve hemangioma in the middle ear

Abstract

Facial nerve hemangioma is a rare and benign vascular tumor, and accounts for 0.7% of intratemporal tumors. We report the second case described in the literature of a facial nerve hemangioma in its tympanic segment. A 14-year-old male patient presented with a history of progressive right ear hearing loss with preserved facial mimicry. Pure tone audiometry showed a right ear moderate conductive hearing loss. Magnetic resonance imaging demonstrated an expansive lesion involving the tympanic segment of the right facial nerve, suggestive of hemangioma. Watchful waiting was chosen as management. In the first case of middle ear facial hemangioma described in the literature, facial palsy was the symptom that led the patient to seek medical care. In the present case, it can be inferred that the first symptom was conductive hearing loss ipsilateral to the lesion. Facial palsy may not be present and the clinical presentation may resemble otosclerosis, ossicular chain disruption, and third window abnormalities, among other differential diagnoses of conductive hearing loss. The second case of tympanic portion facial nerve hemangioma is reported, describing the specificity of conductive hearing loss as its only clinical manifestation.

Facial Nerve Hemangioma of the Lateral Portion of the Internal Acoustic Canal: A Case Report and a Review of Literature

“…They are slow-growing lesions derived from the perineural capillaries, which are very present mainly around the geniculate ganglion, hence their predilection for this location. 1 2 Despite being classically called hemangiomas, these lesions do not present typical aspects of classic infantile hemangiomas, but rather irregular and dilated vessels without an elastic inner layer associated with vascular smooth muscle. 2 They also have intratumoral calcified spicules, derived from the adjacent bone tissue.…”

“… 2 6 On MRI, hemangiomas show a variable intensity signal at T1 (normally slightly hyperintense), hyperintense signal at T2, and have a heterogeneous contrast enhancement—due to the bone spikes. 1 2 6 They are usually small lesions that infiltrate the nerve. This is the main reason that it is a symptomatic lesion even when small, unlike schwannoma, which, due to the lack of nerve infiltration, usually present symptoms when with a significant volume.…”

“…Facial nerve hemangioma (FNH) constitutes only 0.7% of intratemporal tumors. 1 2 Although it can occur in any portion of the facial nerve, it predominantly appears near the geniculate ganglion, being quite uncommon in other portions. 1 3 Facial palsy (mild and progressive, recurrent or spasms) and hearing loss are the most common symptoms.…”

“… 1 2 Although it can occur in any portion of the facial nerve, it predominantly appears near the geniculate ganglion, being quite uncommon in other portions. 1 3 Facial palsy (mild and progressive, recurrent or spasms) and hearing loss are the most common symptoms. Depending on the tumor location in the fallopian canal, one or another is more evident.…”

“…Depending on the tumor location in the fallopian canal, one or another is more evident. 1 3 Its diagnosis is made through complementary imaging exams and requires a high level of suspicion, especially in symptomatic small lesions.…”