Intraparotid facial nerve schwannoma: diagnosis and management.
OBJECTIVE
Facial nerve schwannomas are rare neoplasms that present a challenge in diagnosis and management. We sought to gain insight into the clinical presentation and its implications in management.


METHODS
A group of patients diagnosed with schwannoma was reviewed, with focus on tumor arising in the intraparotid region of the facial nerve. The patient population consisted of 3722 patients evaluated retrospectively over 38 years at the Shadyside Facial Paralysis Center, a tertiary referral center. From this population, 29 patients (18 women and 11 men) with the diagnosis of schwannoma were selected for review.


RESULTS
Twenty-nine patients had facial nerve schwannoma. The average age at diagnosis was 44 years (range, 7 to 78 years). Eight patients had intraparotid involvement, with 5 having a palpable mass in the parotid. The duration of symptoms averaged 8.4 years overall, with intraparotid involvement averaging 10.9 years. The 8 intraparotid schwannomas had a mean House-Brackmann grade of 1.5/6 at initial presentation. Postoperative facial nerve function was only 4.4/6 for resected intraparotid schwannomas.


CONCLUSIONS
Intraparotid facial nerve schwannomas are slow growing tumors, which are usually asymptomatic but can be painful. Schwannoma should be suspected if the facial nerve cannot be found intraoperatively or if the tumor is intimately associated with the facial nerve. In cases where schwannoma is suspected, biopsy is recommended, while complete resection is postponed to obtain imaging studies to evaluate the extent of disease and to discuss possible outcomes with the patient.


CONCLUSIONS
This article provides guidance for the appropriate management of intraparotid facial nerve schwannoma.
Caughey
Robert J
RJ
Department of Otolaryngology--Head and Neck Surgery, Shadyside Hospital Facial Paralysis Center, Pittsburgh, Pennsylvania 15232, USA.
May
Mark
M
Schaitkin
Barry M
BM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D005154:Facial Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005155:Facial Nerve Diseases / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009442:Neurilemmoma / Q000175:diagnosis* / Q000601:surgery*; D035421:Parotid Region / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome