Facial Nerve Paralysis Secondary to Occult Malignant Neoplasms

Abstract

Occult malignancy of the facial nerve may cause unilateral facial paralysis in patients with normal clinical and imaging findings.

Facial motor nuclei cell loss with intratemporal facial nerve crush injuries in rats

“…Unfortunately some patients with facial paralysis and negative imaging studies might have malignancies that might only be found on facial nerve exploration. 28,29 Facial nerve decompression surgery for traumatic facial nerve injury and facial nerve cable grafting are usually able to provide adequate facial nerve functional recovery. [30][31][32] However, even adequate recovery from a surgical standpoint might leave the patient with significant problems in social functioning 33 and inability to effectively communicate emotional expression.…”

Peripheric facial paralysis as initial manifestation of occult metastatic neoplasia

“…The main primary sites were, in decreasing order, breast, lung, kidney, stomach, and prostate cancers. 3 The main symptoms are facial paralysis, hypoacusis, tinnitus, altered bodily balance, and vertigo; these symptoms may be isolated or associated. 1,3,4 Cases of facial paralysis secondary to malignances generally have a poor prognosis; the paralysis progresses and does not regress with any therapy, which is uncommon in Bell's palsy cases.…”

“…3 The main symptoms are facial paralysis, hypoacusis, tinnitus, altered bodily balance, and vertigo; these symptoms may be isolated or associated. 1,3,4 Cases of facial paralysis secondary to malignances generally have a poor prognosis; the paralysis progresses and does not regress with any therapy, which is uncommon in Bell's palsy cases. 1,3,4 The etiological diagnosis may be delayed, which worsens the prognosis.…”

“…1,3,4 Cases of facial paralysis secondary to malignances generally have a poor prognosis; the paralysis progresses and does not regress with any therapy, which is uncommon in Bell's palsy cases. 1,3,4 The etiological diagnosis may be delayed, which worsens the prognosis. Exams are mandatory in such cases, especially magnetic resonance imaging.…”

Clinical Reasoning: A 50-year-old woman with deep stabbing ear pain

“…5 Red flags for nonviral etiologies include slowly progressive symptoms, a lack of improvement after 6 months, bilateral facial paresis, significant involvement of other cranial nerves, and associated systemic illness. 4,6 If these are present, consider a contrastenhanced brain MRI, with special attention to the facial nerve including the parotid gland. A CT of the temporal bone can help assess the structure of the facial canal.…”