A Novel Surgical Option Using Tissue Expanders for Intraparotid Facial Nerve Schwannoma

Abstract

Intraparotid facial nerve schwannomas (IFNSs) are slow-growing benign tumors. Their management is challenging due to their rare presentation. There are few reports on treatment strategies for IFNSs that have recurred after surgery; thus, the management of recurrent or regrown IFNSs is not standardized. We report a case of a regrown IFNS in a 38-year-old woman who had undergone subtotal resections twice and who developed moderate paralysis in the right mandibular branch of the facial nerve after the second surgery. Preoperative biopsy revealed infiltration of the tumor into the dermis, although there was no sign of malignant transformation. Thus, we performed a 2-stage surgery: in the first operation, we inserted tissue expanders, and in the second operation, we performed a subtotal resection of the tumor and resection of the overlying skin. After the operations, no facial nerve palsy was observed, and an aesthetically favorable result was achieved with scars being minimally visible. No evidence of tumor recurrence was observed during the 12-year follow-up period. Our case suggests that subtotal resection combined with the use of a tissue expander may be a surgical option for regrown IFNS cases with normal to moderate facial nerve function.

Fig. 1.

Findings at the initial presentation. A multinodular mass extends from the right ear to the neck.

Fig. 2.

Preoperative pathological findings. Multiple nodular lesions with clear boundaries were identified in the dermis. The nodular lesions were composed of eosinophilic spindle cells showing a nuclear palisading pattern. Cellular atypia was not observed.

Fig. 3.

Image showing the full expansion of the tissue expanders. Tissue expanders with a size of 3 × 8 cm (65 mL) and 5 × 10 cm (175 mL) were placed in the right cheek and right neck, respectively.

Fig. 4.

Findings at 3 years postoperatively. The surgical outcome was aesthetically favorable, with minimal scarring. No tumor regrowth was observed.