Facial palsy: unusual etiology

Area of Science:

• Neurology
• Oncology

Background:

• Bell's palsy is a common diagnosis for sudden facial paralysis.
• Malignant neoplasms rarely cause facial nerve paralysis.

Observation:

• Three patients initially diagnosed with Bell's palsy were found to have facial nerve paralysis due to malignancy.
• Two cases involved breast carcinoma metastases to the facial nerve, presenting with recurrent, brief episodes of paralysis and pain.
• One case involved parotid adenocarcinoma affecting the facial nerve distal to the stylomastoid foramen.

Findings:

• Metastatic breast carcinoma presenting as facial paralysis is rare, especially with recurrent, episodic symptoms.
• Parotid adenocarcinoma involving the facial nerve distal to the stylomastoid foramen is also exceptionally uncommon.
• These cases challenge typical presentations of metastatic disease and Bell's palsy.

Implications:

• Thorough otoneurologic examination is crucial for patients suspected of having Bell's palsy.
• Facial paralysis, particularly with atypical features, warrants investigation for underlying malignancy.
• Early diagnosis of malignancy presenting as facial nerve involvement can improve patient outcomes.