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Diagnostic Paradox behind Facial Nerve Schwannoma

Background: Schwannomas are benign and slow growing tumors that arise from the Schwann cells which ensheath the axons of peripheral nerve, cranial nerve and autonomic nervous system. A schwannoma of facial nerve may originate from extra or intra cranial segments of the nerve. Most of the facial nerve schwannomas originate from intra-tympanic region. In decreasing order of their frequency, schwannomas were found along the tympanic, mastoid (vertical), labrynthine and meatal segments of the facial nerve. It is an extremely rare entity as malignant degeneration of schwannomas is not frequent. A high level of clinical suspicion with detailed neuro-otological and radiological studies play important role in preoperative diagnosis of schwannomas.

Case presentation: We reported a case of 35-year-old male with progressive right sided facial asymmetry, sudden onset hearing loss and non-pulsatile tinnitus in right ear. The patient’s presentation and diagnostic examinations helped us to reach a provisional diagnosis though final diagnosis was done on the basis of histopathological examination of the excised tumor which was suggestive of facial nerve schwannoma.

Conclusion: The rare and inconsistent clinical presentation and radiological pattern of facial schwannoma often leads to a delayed and indefinite diagnosis. The critical step in management of diverse lesion is diagnosis for the management of facial schwannoma. This report is about a challenging case of facial nerve schwannoma in intra-tympanic region which was diagnosed and managed in our institution.


Saumya Mishra, Haritosh K Velankar, Merin Sara Mathew, Roshni K and Yogesh G Dabholkar

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