Facial Paralysis and Occult Parotid Cancer: A Characteristic Syndrome

Facial Nerve Paralysis Secondary to Occult Malignant Neoplasms

“…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.…”

“…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 …”

Facial Palsy, Radiographic and Other Workup Negative

“…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.…”

“…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.…”

Parotidectomy—Anatomical considerations

“…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.…”