Complete Facial Paralysis Caused by Stabbing With a Car Key at the Stylomastoid Foramen

Non-iatrogenic traumatic facial paralysis is most common in intratemporal facial nerve injury caused by temporal bone fracture, followed by intraparotid facial nerve branch injury. Facial paralysis caused by injury to the extratemporal trunk of the facial nerve is extremely rare. We present a case of a 60-year-old man suffering from immediate complete left peripheral facial paralysis due to blunt transection of extratemporal trunk of facial nerve by stabbing with a car key. There was a facial nerve defect about 1 cm in length. The great auricular nerve was grafted to repair the facial nerve. Over 12 months, his facial nerve function improved to a House–Brackmann III/VI.

Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video

Facial nerve schwannomas can develop at any portion of the facial nerve.1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance.1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation.1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity.4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.

Great auricular nerve schwannoma: a rare presentation and literature review

Head and neck schwannomas are a rare form of tumour arising from the nerve sheath. They are often slow growing and asymptomatic, posing a diagnostic challenge for clinicians. The great auricular nerve (GAN) provides cutaneous innervation to the lower pinna, ear lobule and the inferior periauricular area. Hence, surgical management of GAN schwannomas can have sensory and functional dysfunction postoperatively, necessitating good counselling and communication with the patient. We present the first documented case of GAN schwannoma in the West, with literature review and considerations for surgical management.