Acute facial paralysis due to primary squamous cell carcinoma of the parotid gland.

The incidence of primary squamous cell carcinoma in salivary gland tumours is rare. The first presenting symptom of a salivary gland tumour is usually a painless lump. Acute facial paralysis is uncommon to be the initial presentation. This case report describes a patient of acute facial paralysis due to primary squamous cell carcinoma of parotid gland who was initially incorrectly labelled as a case of Bell's palsy. He was managed successfully with total parotidectomy, neck dissection, facial nerve sacrifice with immediate cable graft reconstruction and fascia lata sling followed by postoperative radiotherapy. The sacrifice of the extra-temporal part of the facial nerve in rare cases can be unavoidable during parotid resections for malignancy when the nerve is grossly involved by the tumour. It is important in this situation that some form of nerve repair and/or facial rejuvenation is undertaken to avoid the unpleasant sequele of facial paralysis. His postoperative facial symmetry improved at rest and one year later he regained satisfactory eye closure and smile. Not all facial paralysis is Bell's palsy. All patients who are labelled as Idiopathic facial paralysis or Bell's palsy should have adequate clinical evaluation with detailed history and proper physical examination.