Seu Michelle, Eggerstedt Michael, Ghai Ritu, Dorafshar Amir H, Wiet R Mark
Division of Plastic Surgery.
Department of Otorhinolaryngology - Head and Neck Surgery.
J Craniofac Surg. 2021 Jun 1;32(4):1361-1364. doi: 10.1097/SCS.0000000000007407.
Facial paralysis can drastically diminish satisfaction in one's social interactions and overall quality of life. Bell palsy is the most common cause of facial palsy, however, a diagnosis of "atypical" BP may originate from an entirely different pathological process. This case highlights a rare case of facial nerve paraganglioma, initially misdiagnosed as BP, that resulted in facial paralysis from neoplastic invasion of the facial nerve.
A 66-year old Hispanic woman with systemic lupus erythematosus presented to the plastic surgery clinic with complaints of drooling and being unable to smile. She experienced several episodes of left facial paralysis and was diagnosed with BP at an outside institution. Each episode was only partially responsive to steroid therapy. Imaging at our institution demonstrated lobulated enhancement along the vertical and extratemporal segments of the facial nerve, which prompted surgical intervention. The patient underwent left transmastoid approach for removal of the lesion involving the facial nerve followed by facial nerve reanimation via gracilis free flap without complication.
This report outlines an extraordinarily rare case of a patient with facial nerve paraganglioma. This case represents the importance of reconstructive surgeons in considering a thorough diagnostic work-up with imaging and histopathology in the setting of idiopathic facial paralysis. Successful collaboration between otolaryngology and plastic surgery made streamlined diagnosis and surgical treatment of this unique case possible.
面瘫会严重降低患者在社交互动中的满意度以及整体生活质量。贝尔面瘫是面瘫最常见的病因，然而，“非典型”贝尔面瘫的诊断可能源于完全不同的病理过程。本病例突出展示了一例罕见的面神经副神经节瘤，最初被误诊为贝尔面瘫，最终因肿瘤侵犯面神经导致面瘫。
一名66岁患有系统性红斑狼疮的西班牙裔女性因流口水和无法微笑前往整形外科诊所就诊。她曾经历数次左侧面瘫，在外院被诊断为贝尔面瘫。每次发作仅对类固醇治疗有部分反应。我院的影像学检查显示面神经垂直段和颞外段呈分叶状强化，这促使进行手术干预。患者接受了经左侧乳突入路切除累及面神经的病变，随后通过股薄肌游离瓣进行面神经重建，未出现并发症。
本报告概述了一例极为罕见的面神经副神经节瘤患者病例。该病例体现了重建外科医生在特发性面瘫情况下考虑通过影像学和组织病理学进行全面诊断检查的重要性。耳鼻喉科和整形外科之间的成功合作使得对这一独特病例进行简化诊断和手术治疗成为可能。
