Fukumoto Yasuhiro, Akita Shinsuke, Mitsukawa Nobuyuki
From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
Plast Reconstr Surg Glob Open. 2025 Jul 16;13(7):e6978. doi: 10.1097/GOX.0000000000006978. eCollection 2025 Jul.
Intraparotid facial nerve schwannomas (IFNSs) are slow-growing benign tumors. Their management is challenging due to their rare presentation. There are few reports on treatment strategies for IFNSs that have recurred after surgery; thus, the management of recurrent or regrown IFNSs is not standardized. We report a case of a regrown IFNS in a 38-year-old woman who had undergone subtotal resections twice and who developed moderate paralysis in the right mandibular branch of the facial nerve after the second surgery. Preoperative biopsy revealed infiltration of the tumor into the dermis, although there was no sign of malignant transformation. Thus, we performed a 2-stage surgery: in the first operation, we inserted tissue expanders, and in the second operation, we performed a subtotal resection of the tumor and resection of the overlying skin. After the operations, no facial nerve palsy was observed, and an aesthetically favorable result was achieved with scars being minimally visible. No evidence of tumor recurrence was observed during the 12-year follow-up period. Our case suggests that subtotal resection combined with the use of a tissue expander may be a surgical option for regrown IFNS cases with normal to moderate facial nerve function.
腮腺内面神经鞘瘤（IFNS）是生长缓慢的良性肿瘤。由于其表现罕见，其治疗具有挑战性。关于IFNS术后复发的治疗策略的报道很少；因此，复发性或再生长性IFNS的治疗尚未标准化。我们报告一例38岁女性的再生长性IFNS病例，该患者曾接受过两次次全切除术，第二次手术后右侧面神经下颌支出现中度麻痹。术前活检显示肿瘤浸润至真皮层，尽管没有恶变迹象。因此，我们进行了两阶段手术：在第一次手术中，我们植入了组织扩张器，在第二次手术中，我们进行了肿瘤次全切除和覆盖皮肤切除。术后未观察到面神经麻痹，瘢痕最小可见，获得了美观的效果。在12年的随访期内未观察到肿瘤复发的证据。我们的病例表明，次全切除联合使用组织扩张器可能是面神经功能正常至中度的再生长性IFNS病例的一种手术选择。
