Management of intraparotid facial nerve schwannomas

Background: The purpose of the present paper was to review the management o f intraparotid facial nerve schwannoma so as to discuss its clinical presen tation, evaluate the various possible diagnostic investigations, and compar e the various surgical options and outcome. Methods: Case series was undertaken of five (1.3%) patients with facial ner ve schwannoma out of 400 consecutive parotidectomies at Singapore General H ospital. Results: There were three men and two women with an age range of 29-65 year s. Three patients presented with painless parotid lumps while two had painf ul parotid swellings. None had facial nerve paresis. Only one patient had p reoperative diagnosis suspicious of schwannoma by fine-needle aspiration cy tology (FNAC). Diagnoses were made intraoperatively. Four patients had exci sion with cable grafting: of the nerve defect, achieving facial nerve grade II-IV (House-Brackmann scale). One patient who underwent enucleation of tu mour with nerve preservation achieved grade II. Conclusions: Preoperative diagnosis is difficult but it is important for di scussion of the extent and options of surgery. Fine-needle aspiration cytol ogy holds promise in making a preoperative diagnosis. Enucleation with nerv e preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.