Occipital Bone Osteosarcoma and Facial Nerve Palsy

While osteosarcoma of the craniofacial bone is rare and therapeutic guidelines are not yet set malignant bone and soft tissue tumors must be considered if facial nerve palsy depends on pathological changes external to the temporal bone. A 45-year-old man admitted and treated for right idiopathic facial nerve (Bell’s) palsy experienced complex dysphagia a month later. Bone window computed tomography (CT) showed osteoblastic and osteolytic changes in the right occipital bone and skull base. Magnetic resonance imaging (MRI) indicated tumor compression of the vertical inferior facial nerve without change in the horizontal portion or the geniculate ganglion. Histologically, the diagnosis was osteoblastic osteosarcoma. Chemotherapy for a metastatic lung lesion was abandoned however, due to the complications of renal failure, and the man died 6 months after first being seen.