Pseudotumoural hypertrophic neuritis of the facial nerve

In a retrospective study of our cases of recurrent paralysis of the facial nerve of tumoural and non-tumoural origin, a tumour-like lesion of the intra-temporal course of the facial nerve, mimicking facial nerve schwannoma, was found and investigated in 4 cases. This was defined as, pseudotumoral hypertrophic neuritis of the facial nerve. The picture was one of recurrent acute facial palsy with incomplete recovery and imaging of a benign tumour. It was different from the well-known recurrent neuritis, hypertrophic neuropathy and perineuroma. A portion of the intra-temporal course of the nerve with concurrent dilatation of the osseous walls was diagnosed pre-operatively as facial nerve schwannoma. The pathological picture showed inflammatory hypertrophy which was not a schwannoma but was likely of viral origin, with degeneration-regeneration of fibres and new connective tissue. Resection of the involved portion of the facial nerve and autologous graft in two cases was performed, decompression with biopsy in the other two. No recurrence of new episodes of paralysis after surgery was observed.