Intra-parotid facial nerve neuroma, an overlooked differential for a parotid lesion

Facial nerve neuromas rarely occur in the intra-parotid segment of the facial nerve and when they do, masquerade as a parotid lump. The imaging and clinical features of the intra-parotid facial neuroma overlaps with the more commonly encountered salivary gland neoplasms and is thus overlooked. However, if not recognized, may result in serious and avoidable adverse events for the patient if biopsied or surgically removed. These include pain, facial nerve palsy and cosmetic deformity. In this report, we present the case of a 47-year-old male patient with an intra-parotid facial nerve neuroma with images including computer tomography, magnetic resonance imaging and intra-operative photos. The lesion was eventually left in situ to avoid facial nerve palsy and preserve cosmesis. A discussion of the imaging characteristics and differential diagnoses is subsequently elaborated.