A Case of Huge Intratemporal Facial Neurinoma

Although the main symptom of facial nerve neurinoma is facial paralysis, it has been reported that about 30% of patients with facial nerve tumor do not demonstrate symptoms of facial paralysis at the initial diagnosis. Although facial nerve neurinoma is a benign tumor that can be completely treated by surgical extraction, irreversible facial paralysis is almost unavoidable. Therefore, one method is to wait until facial paralysis has clearly developed before performing surgery. However, enlargement of the tumor may cause destruction of adjacent organs and serious complications. Therefore, we must carefully consider the surgical timing as well as how we explain the risk of complications to the patient.In this case, there was an interval of six years from the initial diagnosis of neurinoma until the patient consented to surgery. The tumor had extended from the horizontal portion of the facial nerve to the parotid gland, and destroyed not only the facial canal but also the structures of the middle ear and the posterior wall of the external auditory meatus, causing conductive hearing loss. Severe facial paralysis and moderate conductive hearing loss was present at the time of surgery. Postoperative functional loss was minimized by performing tympanoplasty type III and facial nerve reconstruction by interposition to the hypoglossal nerve.