Intraparotid Neurofibroma of the Facial Nerve: A Case Report

Document Type : Case Report

Authors

Department of Otorhinolaryngology , Faculty of Medicine, Zagazig University, Egypt.

Abstract

Introduction:
Intraparotid neurofibromas of the facial nerve are extremely rare and mostly associated with neurofibromatosis type 1 (NF1).
Case Report:
This is a case of a healthy 40-year-old man, which underwent surgery for a preoperatively diagnosed benign parotid gland lesion. After identification of the facial nerve main trunk, a single large mass (6 x 3 cm) incorporating the upper nerve division was observed. The nerve portion involved in the mass could not be dissected and was inevitably sacrificed with immediate neuroraphy of the upper division of the facial nerve with 6/0 prolene. The final histopathology revealed the presence of a neurofibroma. Complete left side facial nerve paralysis was observed immediately postoperatively but the function of the lower half was returned within 4 months and the upper half was returned after 1 year. Currently, after 3 years of follow up, there are no signs of recurrence and normal facial nerve function is observed.
Conclusion: 
Neurofibroma should be considered as the diagnosis in a patient demonstrating a parotid mass. In cases where it is diagnosed intraoperatively, excision of part of the nerve with the mass will be inevitable though it can be successfully repaired by end to end anastomosis.

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1. Chiang C W, Chang Y L,  Lou P J. Multicentricity of intraparotid facial nerve schwannomas. Annals of Otology Rhinology and Laryngology 2001; 110(9): 871-4.‏
2. Marchioni D, Ciufelli MA,  Presutti L. Intraparotid facial nerve schwannoma: literature review and classification proposal. The Journal of Laryngology & Otology 2007; 121(08): 707-12.‏
3. Sullivan MJ, Babyak JW, Kartush JM. Intraparotid facial nerve neurofibroma.The Laryngoscope 1987; 97(2): 219-23.‏
4. Neely J G. Neoplastic involvement of the facial nerve. Otolaryngologic clinics of North America 1974; 7(2): 385-6.‏
5. Hehar SS, Dugar J, Sharp J. The changing faces of a parotid mass. The Journal of Laryngology & Otology 1999; 113(10): 938-41.‏
6. Kavanagh KT, Panje WR. Neurogenic neoplasms of the seventh cranial nerve presenting as a parotid mass.American journal of otolaryngology 1982; 3(1): 53-6.‏
7. Balle VH, Greisen O. Neurilemmomas of the facial nerve presenting as parotid tumors.The Annals of otology, rhinology, and laryngology 1983; 93(1 Pt 1): 70-2.‏
8. Conley J, Janecka I. Neurilemmoma of the facial nerve. Plastic and reconstructive surgery 1973; 52(1): 55-9.‏
9. Pulec JL. Symposium on ear surgery. II. Facial nerve neuroma. The Laryngoscope 1972; 82(7):  1160-76.‏
10. Kavanagh KT, Panje WR. Neurogenic neoplasms of the seventh cranial nerve presenting as a parotid mass.American journal of otolaryngology 1982; 3(1): 53-6.‏
11. Gutmann DH, Collins FS. The neurofibromatosis type 1 geneand its protein product, neurofibromin. Neuron 1993; 10(3):335-43
12. McGuirt WF, Johnson PE, McGuirt WT. Intraparotid facial nerve neurofibromas. The Laryngoscope 2003; 113(1): 82-4.‏
13. Prasad S, Myers EN, Kamerer DB, Demetrsis AJ. Neurilemmoma(schwannoma) presenting as a parotid mass. OtolHead Neck Surg 1993; 108(1):76–9.
14. Kumar BN, Walsh RM, Walter NM, Tse A, Little JT. Intraparotid facial nerve schwannoma in a child. The Journal of Laryngology & Otology 1996; 110(12): 1169-70.‏
15. Sellars SL. Neurofibroma of the facial nerve. South African medical journal=Suid-Afrikaansety- dskrifvirgeneeskunde 1972; 46(37): 1332-4.‏
16. Saleh E, Achilli V, Naguib M, Taibah AK, Russo A, Sanna M, Mazzoni A. Facial nerve neuromas: diagnosis and management. Otology &Neurotology 1995; 16(4): 521-6.‏
17. Albernaz MS, Pratt MF, Garen PD. Intraparotid facial nerve neurofibroma: a case report and literature review. Otolaryngology--Head and Neck Surgery 1990; 102(4): 413-15.‏
18. Kumar A, Ranjan R, Kumar S, Radder S, Rana RS, Bhagat S. Intra-parotid neurofibroma of facial nerve: a case report. International Journal of Medical Research & Health Sciences  2013; 2(3): 716-18.‏