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Management of facial nerve schwannoma: when is the timing for surgery

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Although the estimated prevalence is extremely low, facial nerve schwannoma (FNS) is the most common primary tumor of the facial nerve (FN). In the present study, the outcome of surgical management in 18 patients with FNS was analyzed and an appropriate time for surgery was proposed.

Materials and methods

A total of 18 patients with FNS who underwent surgical management by a single surgeon from 1999 to 2018 were retrospectively analyzed.

Results

Among the 18 patients, five had no facial paralysis before surgery. Near-total removal was performed in three cases, and two cases were managed with decompression. In 13 cases with various degree of preoperative facial palsy, nerve continuity was lost during surgery. FN was reconstructed using cable graft in ten cases, direct anastomosis in one case, and facial-hypoglossal nerve transfer in one case. Facial reanimation surgery without FN reconstruction was performed in one case due to a long-standing facial paralysis before surgery. Preoperative House-Brackmann (H-B) grade in all patients was significantly worse as tumor size increased. The correlation was not observed between the duration and severity of preoperative facial palsy.

Analysis of 12 patients who underwent FN reconstruction revealed that all patients with good preoperative facial function (H-B grade II–III) recovered to H-B grade III after surgery (7/7, 100%). However, patients with poor preoperative facial function (H-B grade IV or worse) had only a 40% (2/5) chance of improving to grade III after surgery. Preoperative tumor size and duration of facial palsy did not affect postoperative final facial function.

Conclusion

We suggest that H-B grade III facial palsy is the best time for surgical intervention, regardless of the tumor size or duration of facial palsy.

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Funding

The authors have no funding and financial relationships.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    Young Sang Cho & Yang-Sun Cho

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University Hospital, Cheonan, South Korea

    Ji Eun Choi

  3. Center for Clinical Epidemiology, Samsung Seoul Hospital, Seoul, South Korea

    Ji Hyun Lim

Authors
  1. Young Sang Cho
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  2. Ji Eun Choi
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  3. Ji Hyun Lim
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  4. Yang-Sun Cho
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Contributions

YSC and Y-SC designed the research; YSC and JEC collected data; YSC and JHL analyzed data; YSC wrote the main paper; Y-SC provided critical revision, discussed the results and implications, and commented on the manuscript at all stages.

Corresponding author

Correspondence to Yang-Sun Cho.

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All the authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any animal studies conducted by the authors. The study was conducted in accordance with the guidelines of the Helsinki Declaration and its subsequent amendments.

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Informed consent was not needed; it is a retrospective study.

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Cho, Y.S., Choi, J.E., Lim, J.H. et al. Management of facial nerve schwannoma: when is the timing for surgery. Eur Arch Otorhinolaryngol 279, 1243–1249 (2022). https://doi.org/10.1007/s00405-021-06765-x

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  • DOI: https://doi.org/10.1007/s00405-021-06765-x

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