Rapid Onset Facial Nerve Paralysis in a Child with Advanced Stage Skull Base Rhabdomyosarcoma: A Case Report and Literature Review

Background This report describes a case of pediatric skull base rhabdomyosarcoma, involving the infratemporal fossa and lateral skull base with extension through the tympanic membrane into the external auditory canal, resulting in unilateral facial paralysis as the sole presenting symptom. Also provided is a literature review of pediatric rhabdomyosarcoma including its management and histological variants.

Case Presentation A 4-year-old boy presented with left unilateral facial nerve paresis progressing to complete paralysis within 1 week. Examination showed a mass occupying the medial external auditory canal and radiographic evaluation revealed a large skull base mass involving the infratemporal fossa and temporal bone with middle fossa extension. Audiogram demonstrated a maximal conductive hearing loss. Biopsy established the diagnosis of stage 3 embryonal rhabdomyosarcoma and the patient was subsequently started on a regimen of concomitant radiation and chemotherapy.

Conclusion While uncommon, facial nerve paralysis may be the first presenting symptom in cases of childhood skull base or temporal bone malignancy, especially in children too young to adequately describe pain, hearing loss, or other symptoms. Facial nerve involvement may indicate more advanced disease stage at diagnosis and thus reflect a poorer prognosis. Progressive facial nerve paresis in children necessitates a thorough head and neck examination and radiographic evaluation to determine etiology and rule out malignancy.