Facial nerve schwannoma – a rare cause of peripheral facial paralysis: clinical case and literature review

Abstract

Facial nerve schwannoma is a benign neoplasm originating from the Schwann cells of the facial nerve. It represents approximately 5% of facial paralysis cases and should be included in the differential diagnosis of peripheral facial paralysis. This neoplasm most frequently affects the tympanic and mastoid segments of the facial nerve. Therapeutic options include surgery, stereotactic radiosurgery or ’wait and scan’.
We describe the case of a patient with an acute peripheral facial palsy, otalgia and left conduction hearing loss, that was interpreted as an acute otitis media complicated with facial paralysis based on the history, physical examination and imaging findings. Due to persistence the patient was submitted to an exploratory tympanomastoidectomy which confirmed the diagnosis of facial nerve schwannoma. During the procedure, a subtotal resection of the lesion was performed, which resulted in postoperative clinical and audiological improvement. After subtotal resection, we opted for regular observation and imaging evaluation of the tumor residue.