A pseudo-malignant Warthin's tumor presenting with facial nerve paralysis

Facial nerve paralysis, in association with a parotid mass, is generally considered pathognomonic of malignancy. However, nine cases of paralysis with benign tumors have been reported: four in association with a pleomorphic adenoma, three with a Warthin's tumor and one with an oncocytoma. The details of these cases are described and an additional case of Warthin's tumor causing a facial paralysis is reported. In all four cases of Warthin's tumor the pathology is similar, with inflammation, fibrosis and necrosis, especially in areas surrounding branches of the facial nerve. In view of the 10 cases reviewed herein, it is suggested that the pathology be confirmed at the time of surgery and every effort made to preserve facial nerve function.