Recurrent Facial Paresis with Facial Neurinoma

PATIENT: A clinical case of a 49-year-old man is described who presented with a right facial paresis for 4 weeks. The patient had undergone a decompression of facial nerve and a radical mastoidectomy elsewhere in 1998 because of a facial paresis and acute mastoiditis. In the following years a complete right facial paresis occurred several times improving with prednisolone. In addition to topognostic examinations a high resolution computed tomography of the temporal bone was made. CT showed a mass in the right tympanic cavity with close contact to the ossicular chain. Diagnostic tympanotomy disclosed a tumor of the tympanic segment of the facial nerve. Pathological examination indicated a diagnosis of neurinoma with an Antoni B architecture. In a second operation the tumor was resected totally and a facial nerve reconstruction was performed by a greater auricular nerve interposition graft. Seven month postoperative beginning nerve reinnervation was seen proceeding continually until the control examination after 1S year. DISCUSSION: Facial neurinoma are a rare course of facial paresis. There are no specific symptoms. That’s why the diagnosis is difficult. But it is necessary to think of with differential diagnosis of facial paresis.