Facial Nerve Schwannoma: The Rare/Great Mimicker of Vestibular Schwannoma/Neuroma

Schwannomas are benign tumors arising from Schwann cells which are a protective casing of nerves, composing myelin sheath and can develop in any nerve where Schwann cells are present. Most common are vestibulocochlear nerve schwannomas. Facial nerve schwannomas (FNSs) are uncommon tumors involving seventh nerve of which geniculate ganglion involvement is most common. Clinical presentations and the imaging appearances of FNSs are influenced by the topographical anatomy of the facial nerve and vary according to the segments involved. We report a case of 73-year-old man presenting with right side facial weakness of lower motor neuron type involvement. Computed tomography and magnetic resonance imaging are clinching the diagnosis. An early diagnosis is important in containing the disease facilitating early surgical intervention.

Extratemporal intraparotid facial nerve schwannoma

Schwannomas of the eighth nerve are common, usually found in syndromic association with neurofibromatosis-2. The occurrence of seventh nerve schwannoma, especially in its extratemporal course, is very rare. Here, we present a case report of an extratemporal facial nerve schwannoma diagnosed preoperatively with cytopathology and postoperative histopathologic confirmation. Histopathology provides the confirmatory diagnosis in such cases. An atypical diagnosis of neural schwannomas should be kept in mind when facial palsy is clinically encountered in the absence of any other aetiological factors.

The surge of Bell’s palsy in COVID - pandemic era

<p class="abstract"><strong>Background:</strong> COVID-19 is declared as a pandemic by WHO. Bell’s palsy is defined as isolated, sudden, peripheral facial paralysis of unknown etiology. Viral infections are capable of causing facial paralysis through infecting the motor neurons of brainstem, seventh nerve ganglia or through infections of supporting cells of the nerve, along with secondary inflammation and oedema, blocking the nerve function. Similarly, coronaviruses are known to have a neuroinvasive propensity.</p><p class="abstract"><strong>Methods:</strong> Our study was aimed to report the increased number of cases of Bell’s palsy in the current COVID pandemic era and to hypothesize the probable role of coronavirus in the pathogenesis of Bell’s palsy. A total of 30 patients presenting with unilateral facial palsy in this COVID era were included in the study. </p><p class="abstract"><strong>Results:</strong> This prospective analysis of Bell’s palsy cases showed 30 cases in the COVID pandemic era, where the total number of OPD patients were 3720. This shows a percentage of Bell’s palsy cases as 0.8 % when compared to 0.05% in the pre-covid time.</p><p class="abstract"><strong>Conclusions:</strong> This study shows that there might be an effect of COVID-19 virus on the immune status of the individuals along with stress induced reactivation of underlying viral infection.</p><p class="abstract"> </p>

Effects of incision location on specimen quality and complications for temporal artery biopsy

Objectives Giant cell arteritis is a vision and potentially life-threatening condition requiring prompt and accurate diagnosis. The current gold standard of diagnosis is temporal artery biopsy. The purpose of this study is to review the technique of temporal biopsy in regard to incision placement, and to determine specimen quality and the incidence of complications, specifically seventh nerve injury. Methods Retrospective cohort study of 125 consecutive patients (137 biopsies) who underwent temporal artery biopsy. Variables concerning the procedure collected included laterality, incision placement, Doppler ultrasound utilization, length of intraoperative and pathologic specimens, result of the biopsy, motor nerve deficit, brow ptosis, and any intra or postoperative complications. Results The patient population was 73% female and 86% Caucasian. The average age at the time of the biopsy was 73.8 (range = 56–89, SD = 8.7). Doppler localization was used on 45% of patients. The mean intraoperative specimen length was 2.6 cm (range = 1.5–4.1, SD = 0.6) and fixed specimen length was 2.0 cm (range = 0.8–4.0, SD = 0.7). Biopsy results were positive in 18% of cases. There were no patients who displayed seventh nerve injury at one-week follow-up. One patient (0.7%) reported persistent anesthesia and one (0.7%) reported persistent paresthesia at the incision site. There were no other intraoperative or postoperative complications reported. Conclusions Placement of the incision at or posterior to the temporal hairline reduces the risk of seventh nerve injury. The posterior incision placement did not affect the quality of specimens or decrease the yield of biopsy results as compared to other studies. The overall complication rate (3%) was minimal and did not involve any motor nerve injury.