[Giant pleomorphic adenoma of the deep lobe of the parotid gland: role of MRI and nerve monitoring in facial nerve localization].
BACKGROUND
Describe, from a clinical case, the usefulness of MRI and nerve monitoring in facial nerve and the interest of the MRI in detecting the position of the facial nerve.


METHODS
A 73 year-old woman has been supported for a huge tumour of the right parotid gland. Clinical examination and preoperative imaging were consistent with a pleomorphic adenoma located in the superficial lobe, with a facial nerve repressed deeply. Resection was performed using a facial nerve monitoring. The nerve was stretched and repressed in superficial position by the tumour. Parotid tissue was repressed by the tumour and the nerve branches were located in subcutaneous position. Tumour resection was achieved in full, without capsular break and without injury to the facial nerve branches.


CONCLUSIONS
Despite recent technological developments, imaging, particularly MRI, can not accurately locate the facial nerve in all cases. A careful search of facial nerve during surgical procedure is always necessary to avoid accidental injury of the nerve. In difficult cases, nerve monitoring is an important technical assistance.
CHU La Timone, Service ORL et Chirurgie Cervico-Faciale, 264 rue Saint Pierre, 13385 Marseille cedex 05, France. Nicolas.fakhry@ap-hm.fr
N
N
Fakhry
J F
JF
Hervé
J
J
Michel
L
L
Santini
P
P
Piller
A
A
Giovanni
D008949:Adenoma, Pleomorphic / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005154:Facial Nerve / Q000033:anatomy & histology; D020220:Facial Nerve Injuries / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D016343:Monitoring, Intraoperative / Q000379:methods*; D010307:Parotid Neoplasms / Q000473:pathology / Q000601:surgery*