Third Portion Facial Nerve Neuroma: Therapeutic Difficulties

Introduction: Facial nerve neuromas are uncommon benign neoplasms of Schwann cells. These tumors can arise from any segment of the nerve from the cerebellopontine angle to the extratemporal peripheral portion. The site of the neuroma, its extension, and the clinical presentation may determine many difficulties in the management of this tumor. Material and Methods: We present a case of facial nerve neuroma involving the third portion in a 40-year-old male with progressive facial palsy and we discuss the therapeutic problems of this presentation. Results: We report the case of a 40-year-old male followed in our department since 4 years for a facial neuroma of the third portion. The main symptoms are dominated by a slowly progressive right facial palsy without otologic symptoms or headache. Temporal bone CT scan showed the tumor at the level of the mastoid (third portion). A partial denervation of the facial nerve was evaluated by electromyography. After 4 years of follow-up, the patient has a grade II House-Brackmann facial palsy and requests surgery. The indication of surgery is difficult because of the high risk of the iatrogenic aggravation of the facial palsy. Conclusion: Facial nerve neuromas manifest differently according to their localizations. The surgical strategy should be designed based on the location and the extension of the lesion and taking into consideration the risk of the iatrogenic aggravation of facial palsy.