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RACS ASC 2024

Pre-operative Diagnosis and Management of Asymptomatic Facial Nerve Schwannoma Ancient Type: A Case Report

Poster

Presentation Description

Institution: Logan Hospital - QLD, Australia

Tumours from the facial nerve account for <1% of Parotid tumours. Facial nerve schwannomas are benign encapsulated slow-growing tumours arising from nerve sheaths at any nerve segment, from the cerebellopontine angle to the parotid gland (the latter being rare). Management of intra-parotid facial schwannomas can be complex for asymptomatic patients due to the risk of facial nerve weakness from intervention. We present the case of a 33-year-old male referred to our clinic with a painless face mass, that was smooth, mobile, 2x2cm, sitting superior to the left angle of mandible. It was noticed due to cosmetic appearance. US defined it as a 22mm encapsulated intra-parotid lesion. He had no facial palsy or constitutional symptoms, no history of head and neck cutaneous malignancies, and was a non-smoker. FNA returned inconclusive. Core biopsy revealed facial nerve schwannoma ‘ancient’ subtype. Given he remained asymptomatic, he was discussed at an ENT Radiology MDT. Consensus was for clinical and radiological surveillance, with gamma knife therapy should significant enlargement or symptoms arise. Gamma knife therapy, a non-invasive radiosurgical technique, provides a precise and localised treatment approach, which aims to balance preservation of facial nerve function with effective tumor control. The few case studies of intra-parotid facial schwannoma that exist use post-operative diagnosis. This case is unique in that diagnosis was achieved on pre-operative core biopsy. This article demonstrates the benefits of tissue diagnosis for undifferentiated parotid masses prior to excision for fostering patient-tailored care. It also increases knowledge of rarer sub-types of facial schwannomas which can arise in the parotid gland.

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Authors

Authors

Dr Sahil Chopra - , Dr Garth Essig Jr. - , Dr Catherine Barnett -