[Clinical aspects and therapy of extratemporal facial neurinoma].
OBJECTIVE
Extratemporal facial nerve neurinomas are rare. In the present study, the epidemiology, clinical presentation and in particular surgical treatment of this entity was analysed under special focus on facial nerve preservation.


METHODS
22 patients with an extratemporal facial nerve neurinoma of the parotid gland, treated at the University-ENT-Clinic Hamburg-Eppendorf during 1977-1997 were analysed retrospectively.


RESULTS
All patients presented with a unilateral parotid mass, on ultrasound examination regularly an encapsulated intraparotideal tumor. 16 patients (72.7%) had regular facial nerve functioning. 6 patients (27.3%) with partial or complete peripheral facial nerve paralysis were treated with partial or radical parotidectomy because of malignancy possibility. In the group of patients with intact facial nerve, latero-facial (superficial) parotidectomy with segmental nerve resection was undertaken in 9 cases (56.3%) because nerve-continuity was not siezable within the tumor area. In 7 cases (43.7%), tumor-enucleation was feasable with complete nerve preservation. Intraoperative frozen section in a total of 4 (18.2%) patients always showed the correct histopathological diagnosis. No tumor-recurrence was observed in the 15 cases (68.6%) which underwent follow-up.


CONCLUSIONS
In case of extratemporal neurinoma of the parotid gland, preparation of the facial nerve during surgery is often impossible, leading to segmental nerve resections. This decision, however, is made without proof for malignancy. In recognition of the biological behaviour of this entity the authors recommend that after tumor exploration a biopsy should be taken from the periphery of the tumor to exclude malignancy. After diagnosis of a neurinoma a nerve preserving (wait-and-see) approach appears justified.
Jaehne
M
M
Universitäts-HNO-Klinik Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg. jaehne@ukl.uni-hamburg.de
Ussmüller
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005154:Facial Nerve / Q000473:pathology / Q000601:surgery; D005155:Facial Nerve Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010306:Parotid Gland / Q000473:pathology / Q000601:surgery; D010307:Parotid Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis