SURGERY FOR FACIAL NERVE SCHWANOMA

Abstract

　Since the management of facial nerve schwannoma (FNS) is extremely rare intratemporal FNS has the potential to be misdiagnosed as Bell's palsy or intraparotid FNS might be often misdiagnosed as pleomorphic adenoma or another parotid tumor which might lead to a delay in diagnosis. In this manuscript, we have reviewed the literature regarding the management of IFNS and reported the authors' experiences in the treatment of IFNS. In patients with FNS, female sex and involvement of the labyrinthine/geniculate and tympanic segments of the facial nerve predict a higher probability of facial paresis or spasm. When isolated to the posterior fossa or parotid gland, establishing a preoperative diagnosis of FNS is challenging. The correct diagnosis for extratemporal FNS depends mainly on intraoperative observation of the gross relation between the tumor and the FN or excision frozen biopsy examination. Treatment should be tailored according to tumor location and size, existing facial nerve function, patient priorities, and age. The integrity of the FN should be preserved for patients with IFNS using tripping method whenever possible. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve. In order to obtain a better facial outcome, facial nerve is reconstructed also along with facial-hypoglossal nerve anastomosis at the same time. The physical rehabilitation is very important to decrease facial contracture and synkinesis.