Facial Paralysis and Occult Parotid Cancer: A Characteristic Syndrome

Broderick, Joseph P.; Auger, R. Robert; DeSanto, Lawrence W.

doi:10.1001/archotol.1988.01860140093029

Cited by 9 publications

(5 citation statements)

References 17 publications

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“…The progressive triad of ear pain, facial paralysis, and sensory loss in the second and third divisions of the trigeminal nerve has been reported to be highly suggestive of a malignant lesion of the parotid gland, even in the presence of normal findings on noninvasive studies. 5 In our series, 4 of the 5 patients with a histologic diagnosis of SCC had a history of a regional skin SCC. The patients with poorly differentiated carcinoma consistent with SCC on pathologic review also had a history of regional skin SCC.…”

Section: Discussionmentioning

confidence: 72%

“…Complaints of facial paresthesia or hypoesthesia in the trigeminal nerve distribution, dysphagia, and hoarseness were noted in this series. The progressive triad of ear pain, facial paralysis, and sensory loss in the second and third divisions of the trigeminal nerve has been reported to be highly suggestive of a malignant lesion of the parotid gland, even in the presence of normal findings on noninvasive studies 5 …”

Section: Discussionmentioning

confidence: 99%

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Facial Nerve Paralysis Secondary to Occult Malignant Neoplasms

Boahene¹,

Olsen²,

Driscoll³

et al. 2004

Otolaryngol.--head neck surg.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Facial Nerve Paralysis Secondary to Occult Malignant Neoplasms

Boahene¹,

Olsen²,

Driscoll³

et al. 2004

Otolaryngol.--head neck surg.

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“…9 Slow-onset facial palsy accompanied by facial pain or otalgia that does not resolve, zonal (frontal, periorbital, midface, or lower lip weakness) or progressive facial palsy, other cranial neuropathies particularly of cranial neuropathy (CN) V, or a unilateral serous otitis media raises suspicion for an occult malignancy and merit fine-cut CT and MRI imaging along the course of the facial nerve. 1 False-negative MRI findings may occur secondary to perineural invasion in the absence of a gross tumor encasing the nerve, small tumor size, or inadequate coverage of the parotid bed. In a study of 486 patients with unilateral facial palsy, 8 patients had initially negative MRI with no improvement in facial function after 6-30 months and following facial nerve exploration and parotidectomy were found to have acinic cell or basal cell carcinoma, or perineural, intraneural, or perivascular adenoid cystic carcinoma and mucoepidermoid carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Insidiously progressive lower motor neuron or peripheral facial palsy prompts a radiographic and diagnostic workup for a benign facial nerve tumor or a head and neck malignancy. 1,2 When such workup is repeatedly negative, surgical exploration of the parotid gland and facial nerve should be considered because occult perineural malignancy may occur without a discrete tumor. 3 A diagnostic and therapeutic dilemma occurs when surgical exploration is unrevealing or where slow-onset facial palsy occurs in the absence of hematologic, radiographic, or histologic findings over several years.…”

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confidence: 99%

Facial Palsy, Radiographic and Other Workup Negative

et al. 2021

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Objectives:Slow-onset peripheral facial palsy is far less common than acute-onset peripheral facial palsy and necessitates diagnostic evaluation for a benign or malignant tumors, or other less common etiologies. In the rare scenario when no clarifying etiology is discovered following long-term evaluation (no radiographic or hematologic abnormalities and an otherwise unremarkable evaluation), a diagnostic and management dilemma occurs. We present a series of patients with this possible new clinical entity: facial palsy, radiographic and other workup negative (FROWN), and propose a management strategy for this diagnosis of exclusion.Methods:A series of 3,849 patients presenting with facial palsy to a tertiary Facial Nerve Center was retrospectively assessed to identify those with progressive loss of facial function over at least 1 month. Exclusion criteria included history, physical or hematologic findings indicative of known diseases associated with facial palsy, and radiographic studies demonstrating a benign or malignant tumor.Results:Patients with slow-onset facial palsy constituted 5% (190 patients) of the cohort and were ultimately diagnosed with either a benign or malignant neoplasm or other facial nerve pathology. Fourteen patients with slow-onset facial palsy remained without a diagnosis following long-term evaluation and serial imaging. Eleven patients underwent dynamic facial reanimation surgery and facial nerve and muscle biopsy, with no clear histopathologic diagnosis.Conclusion:Patients with slow-onset facial palsy with negative radiographic and medical evaluations over several years may be characterized as having FROWN, an idiopathic and as yet poorly understood condition, which appears to be amenable to facial reanimation, but which requires further investigation as to its pathophysiology.

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“…Facial weakness may be subtle or facial muscle fasciculations may be noted. Facial nerve paralysis is usually an indication of nerve invasion by a malignant tumor (Conley et al,1981; Broderick et al,1988; Frankenthaler et al,1991; Gurney et al,2005). Fixation to skin, decreased mobility, and cervical lymphadenopathy are other signs associated with malignancy.…”

Section: Introductionmentioning

confidence: 99%

Parotidectomy—Anatomical considerations

Wang

Eisele

2011

Clinical Anatomy

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The parotid glands are paired major salivary glands and are located in the preauricular region. Parotidectomy is a surgical procedure that entails removal of all or a portion of the parotid gland. The most common indications for this operative procedure are a neoplasm of the parotid gland or metastases to parotid lymph nodes. An intimate knowledge of the anatomy of the parotid gland and related structures is necessary for the performance of safe and successful parotid surgery. This report will discuss the anatomy of the parotid gland as it pertains to parotid surgery and the avoidance of complications related to this surgery.

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Facial Paralysis and Occult Parotid Cancer: A Characteristic Syndrome

Cited by 9 publications

References 17 publications

Facial Nerve Paralysis Secondary to Occult Malignant Neoplasms

Facial Nerve Paralysis Secondary to Occult Malignant Neoplasms

Facial Palsy, Radiographic and Other Workup Negative

Parotidectomy—Anatomical considerations

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