There are several controversial aspects to the management of traumatic facial paralysis. One of these involves the precise nature of surgical intervention once the decision to operate has been made. Between June 1, 1984, and June 30, 1993, we surgically treated 220 cases of traumatic facial paralysis with good cochlear reserve by decompressing the tympanic and mastoid segments via a transmastoid approach followed by decompression of the geniculate ganglion and the distal half of the labyrinthine segment via a middle fossa approach. We discuss the results of surgery via the middle fossa approach, and we review the literature.
We report a case of perineural invasion of the facial nerve by a cutaneous squamous cell carcinoma in a 59-year-old man who presented with a slowly progressive facial paralysis. We performed a distal facial nerve dissection and a simple mastoidectomy with facial recess exposure for resection to negative margins. We also performed a simultaneous facial reconstruction and reanimation procedure with excellent results. External-beam radiation completed the treatment regimen. In addition to describing this case, we review current concepts in diagnosis and therapy, as well as the historical background of malignant perineural invasion of the cranial nerves.
Neuromuscular choristoma (NMC) is an uncommon tumor that usually involves a large nerve trunk. Only 28 cases of NMC have been previously reported in the English-language literature, 17 of which involved cranial nerves. We report a new case of intracranial NMC that arose from a facial nerve at the cerebellopontine angle in a 44-year-old man. The patient was taken to surgery, where the lesion was found to involve the right facial nerve. The tumor was partially removed, and at the 2-year follow-up, the patient showed no sign of recurrence.