Facial Paralysis due to Benign Parotid Tumors

Fine Needle Aspiration Cytology and Diagnostic Pitfalls in Warthin’s Tumor with Necrotizing Granulomatous Inflammation and Facial Nerve Paralysis

“…Pleomorphic adenoma is the most frequently reported benign parotid tumor associated with facial nerve dysfunction. 18 In the only other report of WT causing facial nerve paralysis, nerve dysfunction was also preceded by a period of rapid tumor growth following apparent spontaneous infarction. 2,16 The most notorious pitfall to the diagnosis of WT is the cystic nature of the tumor.…”

“…3,4,11,15,17 Other reported secondary changes observed with WT include sudden rapid growth of the mass, pain, facial nerve paralysis, fibrosis and necrotizing granulomatous inflammation. 2,8,10,16,18 The variety and frequency of these alterations are best explained by the propensity of WT to spontaneously infarct. 2,8,9,12,14,15 Necrosis causes leakage of cyst contents, which when exposed to adjacent tissues results in a variety of reactive, inflammatory and metaplastic changes that predispose to both clinical and cytologic misinterpretation.…”

“…Cranial nerve VII dysfunction is very rarely caused by a benign salivary gland (SG) tumor, 2,8,16,18 and necrotizing granulomatous inflammation is most characteristic of mycobacterial or fungal infection. This report is probably the first account in which these 2 conditions are observed in a single WT.…”

Salivary Gland Pleomorphic Adenoma

“…Although progression is slow, left untreated, the tumor can cause significant morbidity and, rarely, death. 9,10 Although facial nerve dysfunction at initial presentation is almost always an indication of a malignant lesion, it is rarely observed in patients with locally recurrent parotid pleomorphic adenomas. 10 Approximately 3% to 4% of pleomorphic adenomas may become carcinoma ex-pleomorphic adenomas, an aggressive malignancy that may metastasize and result in death.…”

“…9,10 Although facial nerve dysfunction at initial presentation is almost always an indication of a malignant lesion, it is rarely observed in patients with locally recurrent parotid pleomorphic adenomas. 10 Approximately 3% to 4% of pleomorphic adenomas may become carcinoma ex-pleomorphic adenomas, an aggressive malignancy that may metastasize and result in death. 4,11 The likelihood of malignant transformation increases with the duration of the lesion.…”