Multiple Schwannomas of the facial nerve – a case report

Introduction:

Schwannomas are benign nerve sheath tumors that are common in the head and neck region. If they occur frequently in one patient, they may be associated with neurofibromatosis type I and II. Schwannomas of the facial nerve are extremely rare, with less than 50 case reports worldwide. They can affect any segment of the nerve, most commonly the geniculate ganglion.

Case report:

A 73-year-old patient presented in our clinic with a sudden onset of right lower facial palsy for one month. Initially, CT imaging was performed to exclude a cerebral event showed a tumor within the parotid gland. The ultrasonography and MRI examination revealed multiple lesions along the course of the marginal mandibular branch of the facial nerve without malignancy criteria.

For histological verification, we performed a left-side partial parotidectomy with extirpation of an intraparotideal node, which turned out as a benign schwannoma. The size or rather growth of the further tumors is regularly monitored sonographically. The facial nerve function has remained unchanged since the operation, and fibromatosis has been excluded dermatologically.

Conclusion:

We present so far the first case report of multiple schwannomas of the marginal mandibular branch of the facial nerve. If multiple tumors occur in the parotid gland and the angle of the jaw, this rare differential diagnosis must be considered. In addition to an operative therapy depending on the localization, further treatment options including radiation, off-label immunotherapy or clinical controls must be discussed with the patient.

Publication History

Publication Date:
23 April 2019 (online)