facial neuroma
Introduction
Introduction to facial neuroma A tumor that originates in the facial nerve sheath, also known as a schwannomas or a Schwannian sheath tumor. It can occur on a segment of the whole facial nerve, but there are more around the knee joint. In 1930, Schmidt first reported that there were less than 300 cases in the world literature and only 20 domestic reporters. According to Saito (1972), 5 cases of 600 tibia specimens were found, with an incidence of 0.8%. The tumor grows very slowly and can be asymptomatic for a long time. In the primary segment, the compression of the stenosis of the bone is earlier and heavier than that of the vertical segment. The facial paralysis appears early and heavy, and it can be repeated. 40% of the patients showed facial muscle spasm in the early stage and then turned into facial paralysis. The original in the tympanic segment, in addition to facial paralysis can also have tinnitus, deafness, such as the primary in the inner auditory canal, it is easy to be confused with acoustic neuroma. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: schwannomas, tinnitus, dizziness
Cause
Facial neuroma etiology
Facial schwannomas are derived from Schwann cells of the neuroectodermal leaves. The tumor tissue is distinct from the surrounding borders and has a complete envelope. The facial nerve fibers can be pushed to the periphery without being destroyed. Facial neurofibroma is derived from the inner lining of the mesoderm. It can be single or multiple, and the multiple is neurofibromatosis.
The clinical reasons for this disease are rare:
1 The tumor grows slowly and is asymptomatic at an early stage.
2 When facial paralysis occurs, it is easily misdiagnosed as Bell sputum and chronic otitis media.
3 granulomatous tumors are rarely sent for pathological examination during surgery. Most patients, the youngest reported in the literature is a 4-year-old child.
Prevention
Facial neuroma prevention
There are no special precautions for this disease, and early detection and early diagnosis are the key.
Because of the variety of clinical manifestations of facial neuroma, slow development, it is often easy to ignore or misdiagnosis, many are mistaken for Bell's palsy, often when the tumor is larger or expand to the extracranial expansion, so there is a progressive facial paralysis, unless Has been diagnosed for other reasons, should consider the possibility of this tumor, especially with facial convulsions or paralysis, sudden onset of facial paralysis after full-exploration and no improvement after decompression, should also consider this tumor.
Complication
Facial neuroma complications Complications, schwannomas, tinnitus, vertigo
In general, primary facial neuroma is a benign tumor with slow growth. Among them, facial nerve sheath tumor rarely malignant, while facial nerve fibroma may be malignant. Some facial neurofibroma recurs quickly after multiple operations, and high intracranial pressure symptoms appear. In the short term, the clinical manifestations are malignant.
There are usually three major clinical manifestations depending on the location of the tumor.
1. The facial nerve sheath tumor that occurs in the cerebral cerebral horn and the internal auditory canal is similar to the acoustic neuroma because of compression of the vestibular nerve bundle of the cochlea. Early sensory neurological hearing loss and vestibular dysfunction occur, and the auditory examination is sinus. After sputum, the vestibular symptoms may not be obvious, but the vestibular function test is low or no reaction. Unlike acoustic neuromas, facial nerve sheath tumors can present facial nerve symptoms before or at the early stage of cochlear vestibular symptoms, whereas acoustic neuroma usually has facial nerve symptoms rarely even if the tumor is already very large. In imaging, the facial nerve enlargement of the facial nerve labyrinth is highly suggestive of facial neuroma rather than acoustic neuroma.
2. Tumors that occur in the geniculate ganglia usually first have progressive facial paralysis. If the tumor is confined to the geniculate ganglion, there is no hearing loss. If the tumor is lost to the labyrinth or internal auditory canal, there may be a sensorineural hearing loss. There are tinnitus or dizziness, and if the tumor develops into the tympanic cavity, there may be a conductive hearing loss.
3. The incidence of facial paralysis in tumors that occur in the tympanic or vertical segment is slightly less than in other sites. The posterior tympanic mass or the posterior wall of the external auditory canal can be found during examination. In severe cases, the external auditory canal can be narrowed.
Symptom
Symptoms of facial neuroma Common symptoms Deafness, tinnitus, facial nerve, facial muscle, phrenic nerve fiber overgrowth
The tumor grows very slowly and is asymptomatic for a long time. In the primary segment, the compression of the stenosis of the bone is earlier and heavier than that of the vertical segment. The facial paralysis appears early and heavy, and it can be repeated. 40% of the patients showed facial muscle spasm in the early stage and then turned into facial paralysis. The original in the tympanic segment, in addition to facial paralysis can also have tinnitus, deafness, such as the primary in the inner auditory canal, it is easy to be confused with acoustic neuroma.
Examine
Examination of facial neuroma
Comprehensive facial nerve function tests, such as lacrimal gland, submandibular gland secretion, sacral muscle reflex and tongue taste test, etc., skull base and mastoid X-ray film, visible facial nerve tube bone destruction, CT mastoid and skull base scan diagnosis more meaningful Big. High-resolution CT venography of the humerus is the most accurate method for displaying facial neuroma. Multi-track tomography is also useful to depict subtle bone changes in the facial nerve canal.
Diagnosis
Diagnosis and diagnosis of facial neuroma
Facial nerve tumors have different clinical manifestations due to their different growth sites. Early symptoms are concealed and clinically misdiagnosed. The clinical manifestations of cerebellopontine angles are similar to acoustic neuromas. It occurs in the humerus and appears as sudden facial paralysis. Bell's palsy, all need to be examined by imaging examination. The most common symptom of facial nerve sheath tumor is progressive facial nerve dysfunction. It can also be the first symptom of facial muscle spasm. It should be distinguished from primary facial muscle spasm, primary. The hemifacial spasm is rarely accompanied by facial paralysis.
