Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Oct:111:108850.
doi: 10.1016/j.ijscr.2023.108850. Epub 2023 Sep 20.

Crocodile tears syndrome after vestibular schwannoma surgery: A case report

Yash Asit Gore  1 , Jash Doshi  2 , Dattatray P Muzumdar  2
Affiliations
Case Reports

Crocodile tears syndrome after vestibular schwannoma surgery: A case report

Yash Asit Gore et al. Int J Surg Case Rep. 2023 Oct.

Abstract

Introduction: Crocodile tears syndrome is paroxysmal lacrimal hypersecretion while eating or drinking. It is relatively rare and mainly observed after peripheral facial nerve injury due to any cause.

Presentation of case: We describe a case of crocodile tears syndrome after vestibular schwannoma surgery in a patient with pre-operative trigeminal nerve involvement. We also discuss the various treatment options offered to the patient and the natural course of the illness.

Discussion: It is hypothesized that facial nerve fibers undergo misdirected re-innervation of the lacrimal gland instead of the salivary gland. After vestibular schwannoma surgery, facial nerve palsy is well described. The sensory symptoms are relatively neglected by the surgeon, even though they cause discomfort to the patient. This may be the cause for the underestimation of its incidence.

Conclusion: The knowledge of the incidence, mechanism and natural course of crocodile tears syndrome along with patient education is important to reduce post-operative distress to the patient. We also hypothesize the correlation of crocodile tears syndrome with motor component of facial function and the role of preservation of nervus intermedius in reducing post-operative facial palsy.

Keywords: Crocodile tears syndrome; Facial nerve; Vestibular schwannoma.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Pre-operative and post-operative MRI image.
Fig. 2
Fig. 2
Facial palsy at 6 months follow-up.
Fig. 3
Fig. 3
Paradoxical hyperlacrimation in right eye while chewing food.
See this image and copyright information in PMC

References

    1. Fróis A.T. Tearing with mastication in relation to facial paralysis: a case report of the crocodile tears syndrome. Rev. Port. Med. Geral Fam. 2022 Jul 7;38(3):294–299.
    1. Abul M.H., Arora M., Kaliaperumal C. Crocodile tear syndrome post microvascular decompression of the trigeminal nerve: a case report and literature review. Biol. Eng. Med. Sci. Rep. 2023;9(2):48–51. doi: 10.5530/bems.9.2.11. - DOI
    1. Nakamizo A., Yoshimoto K., Amano T., Mizoguchi M., Sasaki T. Crocodile tears syndrome after vestibular schwannoma surgery. J. Neurosurg. 2012;116(5):1121–1125. doi: 10.3171/2011.12.JNS111859. (Jul 25, 2023) - DOI - PubMed
    1. Modi P., Arsiwalla T. StatPearls [Internet] StatPearls Publishing; Treasure Island (FL): 2023. Crocodile tears syndrome.http://www.ncbi.nlm.nih.gov/books/NBK525953/ [cited 2023 Jul 25]. Available from: - PubMed
    1. Irving R.M., Viani L., Hardy D.G., Baguley D.M., Moffat D.A. Nervus intermedius function after vestibular schwannoma removal: clinical features and pathophysiological mechanisms. Laryngoscope. 1995 Aug;105(8 Pt 1):809–813. - PubMed

Publication types