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DISTANT METASTASIS - The Facial Nerve

Now viewing: Case 11

Case 11 - Advanced adenoid cystic carcinoma of right parotid gland with extensive involvement of facial nerve and geniculate ganglion

This 43-year-old male had an 18-month history of a gradual progressive right facial nerve paralysis beginning with peripheral branches and then progressing to involve the entire nerve prior to medical treatment. A transmastoid exploration was performed. The facial nerve from the stylomastoid foramen to the geniculate ganglion was grossly enlarged with tumor. This was an adenoid cystic carcinoma. A resection of the nerve from the geniculate ganglion to the styloid foramen was performed and all the margins were positive for tumor elsewhere six weeks prior to the admission. The primary site of the lesion was undetermined. Admission CT scan of the temporal bone reveals postoperative status with residual tumor mass along the pathway of the facial nerve. The patient was then treated conservatively with chemotherapy and radiation therapy.
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Coronal CT scan at the level of the cochlear plane: postoperative status with residual soft tissue mass in the region of petrous segment of the facial canal, mainly the geniculate ganglion (arrow). The right cochlea is intact and the right internal acoustic meatus is normal.
Coronal CT scan at the level of vestibular plane: postoperative status with residual soft tissue tumor mass along the medial aspect of the tympanic cavity, mainly in the tympanic segment of the facial canal (arrow).

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Coronal CT scan at the level of mastoid segment of the facial canal: postoperative status with residual soft tissue tumor mass involving most part of the mastoid including stylomastoid foramen (arrow).

 

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