Bangalore: Facial nerve schwannomas are rare slow-growing tumours, accounting for less than 1 per cent of all temporal bone tumours. Schwannoma grows on the seventh cranial nerve of the facial nerve. It is a benign and slow-growing tumour. It is also known as a facial neuroma. The tumour arises from the Schwann cells which surround the axons of peripheral and cranial nerves.
According to cancer.gov, it has affected fewer than 200,000 people across the globe. In India, the incidence of facial nerve schwannoma is 1 in 50,000. Apollo Cancer Centre, Bangalore, recently made a breakthrough in treating facial nerve schwannoma.
Dr Satish Nair, Senior Consultant, ENT & Head and Neck Oncology, Apollo Cancer Centre, Bangalore, and a team of medical experts performed endoscopic trans canal excision of facial nerve schwannoma on a 35-year-old patient who was suffering from right-sided facial weakness for the last two years. 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.
The team did an otoendoscopy that revealed a pinkish-pale non-pulsatile mass behind the intact tympanic membrane at the posterosuperior quadrant. Further examination showed that the patient had right-sided Grade V lower motor neuronal facial palsy. Her high-resolution computed tomography of temporal bone revealed a mass in the facial recess eroding the posterior genu of the facial nerve, which suggests facial nerve schwannoma.
The surgery lasted for two hours wherein the team of doctors performed endoscopic trans canal excision of facial nerve schwannoma with cable grafting using the greater auricular nerve. The patient was discharged on the second postoperative day without any complications.
Dr Nair said, “When we first came across this unique case, we knew the challenges in front of us but the confidence in the new age advanced technology ensured to give required results for the patient. The diagnosis revealed facial nerve schwannoma sits in a complicated position and leads to facial palsy. The surgery was a tough one but with the right technique and expertise, we were able to pull off the world’s first endoscopic trans canal excision of facial nerve schwannoma. The patient is doing well post the surgery.”
Sharing his thoughts on the surgery, Dr Manish Mattoo, Chief-Executive Officer, Apollo Hospitals, Karnataka Region, said, “The unique case addressed by Dr Nair has convinced us that if one pursues any case with passion and intellect, one can invent solutions to help patients in the best way possible.”