Microsoft Word - ORL127BF

Author’s address: P. H. Schmidt, M. D., Diaconesseninrichting Bronovo, Den Haag (Netherlands) The neurinoma of the facial nerve is a rare tumor. The first case was described by Schmidt in 1930. The fact that 30 years later Miehlke could collect only 42 cases of intratemporal neurinoma of the facial nerve justifies the description of another case. A 13-year-old girl had noticed a left side facial palsy for 4 months. The palsy had developped within a day. For 3 months she was treated by a neurologist with electrotherapy. After an initial improvement, the palsy had increased and the patient was referred to the otologist. At that time the palsy was complete. There was no pain. The patient did not volunteer any taste difficulty. Beside an acute middle ear infection 12 years ago, there was no history of ear trouble. Hyperacusis was not noted. There was no pain. The outer ear canal on the left side was squeezed as compared to the round shaped canal at the other side. The bony lining was intact. Both drum membranes were normal. The audiogram showed normal hearing on both ears. X-rays (Stenvers, Schüller, Mayer) showed normal temporal bones. The taste on the anterior two thirds of the left side of the tongue was disturbed. At surgical intervention the superficial mastoid cells were normal. Between the horizontal canal and the stylomastoid foramen, abnormal tissue was found. It was granulationlike, red, soft and quick bleeding. The facial nerve lost itself diffuse in the tumor. Microscopy showed a neurinoma (Fig. 1). In the tumor no facial nerve as such was recognizable, so it was resected to in the normal nerve. The middle ear mechanism and the outer ear canal could be preserved. A 30-mm-long graft, taken from the great auricular nerve, was inserted. General The neurinoma is a tumor of the peripheral nerve, and may be found in the spinal–as well as in the cranial nerve. One differentiates between the multiple neurinoma (as found in Recklinghausen’s “neurofibromatosis”) and the solitary neurinoma. 9* 128 Schmidt, Intratemporal Neurinoma of the Facial Nerve