INDIA — A team of doctors at Apollo Cancer Centre, Bangalore have performed a unique procedure on a 35-year-old Tanzanian patient suffering from facial nerve schwannoma.
The team of doctors led by Dr. Satish Nair, Senior Consultant, ENT & Head, and Neck Oncology, Apollo Cancer Centre, Bangalore, performed endoscopic trans canal excision on the woman who was suffering from right-sided facial weakness for the last two years.
According to the doctors, this is for the first time in the world that the principles of head and neck, lateral skull-base approach, and endoscopic techniques were used together to retain the entire functionality of the ear.
Dr. Nair revealed that they did an otoendoscopy that revealed a pinkish-pale non-pulsatile mass behind the intact tympanic membrane at the posterosuperior quadrant.
Otoendoscopy is a procedure that gives a large field of vision using direct vision and lateral vision endoscopes and reduces surgical approaches.
During an in-depth examination, the team found that the patient had right-sided Grade V lower motor neuronal facial palsy and her high-resolution computed tomography of Temporal Bone revealed a mass, and then she was diagnosed with facial nerve schwannoma.
Dr. Nair claims that this was a special case because the tumor’s complex positioning caused facial palsy.
Dr. Nair’s team decided to perform endoscopic trans canal excision of the facial nerve schwannoma with cable grafting after the diagnosis.
The procedure took two hours, and the patient was released from the hospital without incident on the second postoperative day.
Facial nerve schwannoma, also known as a facial neuroma, is a benign and slow-growing tumor that grows on the 7th cranial nerve of the facial nerve.
It arises from the Schwann cells which surround the axons of peripheral and cranial nerves. Facial nerve schwannomas are rare, accounting for less than 1 percent of all temporal bone tumors.
The facial nerve controls all of the muscles of the face — from the blinking of eyes to the muscles that help with speaking, smiling, etc. It is also the only nerve that exits the brain and comes into the neck through a bony canal in the ear.
“The nerve passes through multiple areas. It goes in between the balance area, hearing area of the ear, into the ossicles (three bones in either middle ear that are among the smallest bones in the human body) and comes out into the skull base,” Dr Nair said.
“Any weakness to this nerve means weakness to one side of the face. A patient cannot smile or talk properly.”
According to cancer.gov, facial nerve schwannoma has affected fewer than 200,000 people across the globe. In India, the incidence of facial nerve schwannoma is 1 in 50,000.
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