Department of Otorhinolaryngology and Head and Neck Surgery, Kameda Medical Center, Kamogawa-shi, Chiba, Japan; Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Auris Nasus Larynx. 2023 Oct;50(5):799-804. doi: 10.1016/j.anl.2022.09.007. Epub 2022 Oct 9.
Cholesterol granulomas (CGs) are frequently found in the temporal bone, but their presence in the facial nerve has not been reported. We report a case of a 58-year-old woman who presented with left facial palsy caused by a CG that appeared to have originated in the facial nerve. Temporal bone computed tomography (CT) revealed soft tissue masses in the left middle ear spaces, and the facial canal was dilated from the genu to the vertical portion. Magnetic resonance imaging (MRI) revealed high signal intensity on T1-weighted images and partially high signal intensity on T2-weighted images, although no significant enhancement was observed on gadolinium-enhanced MRI. Surgical findings revealed CG in the middle ear spaces, but the facial canal remained intact and lacked continuity with the internal mass. Histopathological analysis verified the mass as a CG accompanied by cholesterol crystals. The mass was located within and continuous with the epineurium. These findings indicate that hemorrhage in the facial canal may have triggered the formation of the CG, causing left facial palsy due to increased pressure in the facial canal.
胆脂瘤（cholesterol granulomas，CGs）在颞骨中很常见，但面神经内的胆脂瘤尚未见报道。我们报告了一例 58 岁女性病例，其左侧面神经麻痹是由起源于面神经的胆脂瘤引起的。颞骨计算机断层扫描（CT）显示左侧中耳腔软组织肿块，面神经管从膝状神经节到垂直段扩张。磁共振成像（MRI）显示 T1 加权图像上高信号强度，T2 加权图像上部分高信号强度，但钆增强 MRI 未见明显强化。手术发现中耳腔有胆脂瘤，但面神经管完整，与内部肿块无连续性。组织病理学分析证实该肿块为胆脂瘤，伴有胆固醇结晶。肿块位于神经外膜内并与之连续。这些发现表明面神经管内的出血可能引发了 CG 的形成，导致面神经管内压力增加引起左侧面神经麻痹。
