Recurrent facial nerve palsy caused by a facial cyst

Abstract

Mr B first presented to the authors' department in 2001 complaining of right-sided facial weakness. He was diagnosed with a grade 2 facial nerve palsy for which no obvious cause was identified. He was actively treated with aciclovir and steroids and his symptoms resolved completely. Over the next 2 years, he suffered two similar episodes that responded well to similar treatment. One year later, he was referred to the clinic with a grade 3 facial nerve palsy. A computed tomography scan showed no abnormality along the course of the right facial nerve. Genetic tests showed no genetic cause for the recurrent facial nerve palsy. His symptoms initially resolved but 6 months later he was readmitted with a grade 4 facial nerve palsy. A magnetic resonance imaging scan showed inflammation of the tympanic and mastoid sections of the facial nerve and facial nerve decompression surgery was planned. Intra-operatively, mild oedema was evident along the intratemporal course of the facial nerve. During decompression of the mastoid (horizontal) segment of the facial nerve (Figure 1), a significant amount of mucoid fluid in keeping with a benign cyst was drained (Figure 2). His facial palsy fully resolved and a magnetic resonance imaging scan performed 1 year after surgery showed no evidence of recurrence or other pathology. At 3-year follow up, there was no recurrence of symptoms.

An inferior alveolar intraneural cyst: a case example and an anatomical explanation to support the articular theory within cranial nerves

“…21,27 We wonder if these cases are examples of intraneural ganglion cysts, which can be anatomically explained by articular branches from the TMJ via the communicating auriculotemporal nerve 6,17,24 to the parent facial nerve (Fig. 3D).…”