Cancer in facial nerves









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Geniculate ganglion fossa is considered as the most common site for occurrence of FNS with its extension till tympanic or labyrinthine segments. Because postoperative facial function is usually poor in these patients, some authors advocate a policy of close follow up with serial MRI. In the post-operative follow up after three months patient showed significant improvement in facial palsy with the help of physiotherapy. The facial nerve schwannoma usually manifest with facial palsy and often with an insidious onset. In extreme cases facial nerve has to be sacrificed, thus a permanent facial paralysis is inevitable. However physical examination revealed grade-2 facial palsy on right side. FNSs show multi-segmental involvement which acquires a dumbbell shape, narrow labrynthine segment forms the isthmus of dumbbell between the globular tumor component at Internal acoustic canal and geniculate ganglion.

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In the post-operative follow up after three months patient showed significant improvement in facial palsy with the help of physiotherapy. Unlike schwannoma, malignant preservation difficult. They have a tendency to push axons of nerve of origin away [ 2 ] and so that they can potentially be resected with nerve preservation. The treatment decision should be tailored according to tumor growth, hearing function, surgical experience and facial function deterioration. Sometimes facial nerve schwannoma is bilateral as part of neurofibromatosis-2 spectrum.

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The critical step in management of diverse lesion is diagnosis for the management of facial schwannoma. The intra-cranial portion of facial nerve is devoid of epineurium [ 7 ]. Schwannoma should be suspected if facial nerve cannot be found intraoperatively or if the intra-tympanic tumor is associated with the facial nerve. Surgery would be indicated when facial paralysis progresses or when significant compression of vital structures is noted. Schwannoma is an ectodermal, benign, encapsulated and solitary tumor that originates from Schwann cells of peripheral nerve sheath [ 1 ]. The rare and inconsistent clinical presentation and radiological pattern of facial schwannoma often leads to a delayed and indefinite diagnosis. They have a tendency to push axons of nerve of origin away [ 2 ] and so that they can potentially be resected with nerve preservation.

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Description: Facial nerve schwannomas have variable patterns of clinical presentations and therefore the diagnosis is often not known preoperatively. A year-old man presented to our hospital with complaints of progressive right facial weakness and intermittent twitching of the right eyelid accompanied by hearing loss, tinnitus and sensation of fullness in right ear for 1 month. CT showing soft tissue in antrum. Facial nerve schwannoma are rare and benign intra-tympanic tumors arising from any segment of nerve with a special predilection for the geniculate area which is most commonly involved [ 3 , 4 ]. Occasionally, the geniculate ganglion component of a dumbbell shaped FNS erodes into cochlea and thus mimics a transmodiolar acoustic schwannoma. CT imaging provides useful information for preoperative planning, but MRI is the method of choice for evaluating facial nerve schwannomas. MRI showing soft tissue lesion along tympanic and mastoid segments of right facial nerve. They are typically solitary, unilateral and sporadic in nature. A facial nerve schwannoma in parotid is rarely seen [ 15 , 16 ].
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