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Irreversible facial nerve palsy as a revelator of parotid gland cancer
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  • Joanna Marszał,
  • Anna Bartochowska,
  • Hanna Klimza,
  • Piotr Nogal,
  • Małgorzata Wierzbicka
Joanna Marszał
Poznan University of Medical Sciences

Corresponding Author:joan.marszal@gmail.com

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Anna Bartochowska
Poznan University of Medical Sciences
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Hanna Klimza
Poznan University of Medical Sciences
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Piotr Nogal
Poznan University of Medical Sciences
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Małgorzata Wierzbicka
Poznan University of Medical Sciences
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Abstract

Aim of the study. The goal of the study was to assess the frequency of malignancies hidden under the diagnosis of “Bell’s palsy”. We aimed to create diagnostic algorithm to avoid failures concerning patients whose only symptom of parotid gland cancer was irreversible FNP. Materials and methods. We analyzed 253 consecutive patients with FNP treated in our department in the last 5 years. All patients with irreversible FNP were reassessed in 6-12 months. We underlined all shortcomings in the diagnostics of those in whom malignancies were found out in MRI of the neck and presented the proposal of diagnostic algorithm to avoid missing such an entity. Results. Bell’s palsy was observed in 157 / 253 patients (62.06%), in 36 / 157 (22.92%) it remained permanent. In 4 / 36 patients (11.11%) with irreversible FNP, which constituted 2.54% of all “Bell’s palsy” cases, parotid gland deep lobe mass was found out in MRI. In one patient infiltration of the skull base was diagnosed. Adenoid cystic carcinoma was confirmed in final histopathology in all cases. Conclusions. Our experience has shown that irreversible FNP can be a revelator of the malignant tumor located in the deep lobe of the parotid gland. Contrast-enhanced MRI covering intra- and extracranial segments of facial nerve should be ordered in all cases of FNP without recovery after 4 months. The main point of our study is to underline that the assessment of the deep lobe of the parotid gland with MRI should be included in the standard diagnostic protocol in all irreversible “Bell’s palsy” cases. Key words: Bell’s palsy, facial nerve palsy, parotid gland cancer