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