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Facial nerve management in patients with malignant skull base tumors

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Abstract

Introduction

The course of the facial nerve through the cerebellopontine angle, temporal bone, and parotid gland puts the nerve at risk in cases of malignancy. In contrast to Bell’s palsy, which presents with acute facial paralysis, malignancies cause gradual or fluctuating weakness.

Methods

We review malignancies affecting the facial nerve, including those involving the temporal bone, parotid gland, and cerebellopontine angle, in addition to metastatic disease. Intraoperative management of the facial nerve and long term management of facial palsy are reviewed.

Results

Intraoperative management of the facial nerve in cases of skull base malignancy may involve extensive exposure, mobilization, or rerouting of the nerve. In cases of nerve sacrifice, primary neurorrhaphy or interposition grafting may be used. Cranial nerve substitution, gracilis free functional muscle transfer, and orthodromic temporalis tendon transfer are management options for long term facial paralysis.

Conclusion

Temporal bone, parotid gland, and cerebellopontine angle malignancies pose a tremendous risk to the facial nerve. When possible, the facial nerve is preserved. If the facial nerve is sacrificed, static and dynamic reanimation strategies are used to enhance facial function.

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Fig. 1

(Taken from The Facial Nerve. Slattery WS and Azizzadeh B, ed. 2014)

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(Taken from The Facial Nerve. Slattery WS and Azizzadeh B, ed. 2014)

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Authors and Affiliations

  1. House Ear Clinic, 2100 West Third Street, Los Angeles, CA, 90057, USA

    Laura H. Christopher & William H. Slattery

  2. University of California, Los Angeles, USA

    William H. Slattery

  3. University of Southern California, 2100 West Third Street, Los Angeles, CA, 90057, USA

    William H. Slattery

  4. Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA

    Erin J. Smith

  5. Center for Advanced Head & Neck Surgery, Beverly Hills, CA, USA

    Babak Larian

  6. Clinical Chief of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, USA

    Babak Larian

  7. Facial Paralysis Institute, Center for Advanced Facial Plastic Surgery, Beverly Hills, CA, USA

    Babak Azizzadeh

  8. Division of Head and Neck Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Babak Azizzadeh

Authors
  1. Laura H. Christopher
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  2. William H. Slattery
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  3. Erin J. Smith
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  4. Babak Larian
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  5. Babak Azizzadeh
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Correspondence to Laura H. Christopher.

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Christopher, L.H., Slattery, W.H., Smith, E.J. et al. Facial nerve management in patients with malignant skull base tumors. J Neurooncol 150, 493–500 (2020). https://doi.org/10.1007/s11060-020-03635-0

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  • DOI: https://doi.org/10.1007/s11060-020-03635-0

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