Facial paralysis caused by malignant skull base neoplasms

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Bell palsy remains the most common cause of facial paralysis. Unfortunately, this term is often erroneously applied to all cases of facial paralysis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors performed a retrospective review of data obtained in 11 patients who were treated at a university-based referral practice between July 1988 and September 2001 and who presented with acute facial nerve paralysis mimicking Bell palsy. All patients were subsequently found to harbor an occult skull base neoplasm. A delay in diagnosis was demonstrated in all cases. Seven patients died of their disease, and four patients are currently free of disease.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Although Bell palsy remains the most common cause of peripheral facial nerve paralysis, patients in whom neoplasms invade of the facial nerve may present with acute paralysis mimicking Bell palsy that fails to resolve. Delays in diagnosis and treatment in such cases may result in increased rates of mortality and morbidity.</jats:p></jats:sec>

Management of Bell palsy: clinical practice guideline

“…For patients with no improvement in facial nerve function or progression of facial nerve paralysis, referral to an otolaryngologist may be reasonable to confirm the diagnosis and to exclude other conditions. Referral to a specialist may avoid missed diagnoses of malignant skull-base neoplasms 30 or benign facial nerve schwannomas, 31 which may masquerade as Bell palsy. The possibly catastrophic consequences of having a serious condition that mimics Bell palsy, albeit rare, and the unlikely serious harm associated with referral, motivate this strong recommendation.…”

Determining Etiology of Facial Nerve Paralysis With MRI: Challenges in Malignancy Detection

“…Several authors have shown the limitations of imaging in diagnosing facial nerve tumors. [15][16][17][18] In a retrospective review of 38 patients with histologically proven perineural spread from a head and neck malignancy, Lee et al 19 identified only 1 patient (2.6%) with a preoperative radiology report that identified perineural invasion. The present study recapitulates the conclusion that MRI alone is likely insufficient for differentiating among causes of FNP as only fair agreement regarding final diagnosis was identified for expert rater pairs.…”

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.…”