Question: A 38 year old woman presents for evaluation of facial paralysis. She notes that she was diagnosed with Bell’s palsy 4 years prior. She remembers having partial facial weakness at that time that involved all divisions that slowly got worse over approximately 6 months until she had no appreciable movement. Imaging was never performed. Examination at this time reveals House-Brackmann grade 6 facial function. You obtain an MRI that demonstrates a lesion involving the facial nerve that extends from the mid-IAC to stylomastoid foramen and extends superiorly within the middle fossa, consistent with facial nerve schwannoma. How would you most accurately counsel this patient regarding treatment?

a) Tumor resection and interposition nerve grafting would likely yield House-Brackmann grade 4 facial function at best because the paralysis occurred less than 5 years ago

b) Tumor resection and interposition nerve grafting would likely yield House-Brackmann grade 6 facial function because the paralysis occurred more than 18 months ago

c) The tumor can be resected while maintaining continuity of the nerve; slow recovery of facial function should be anticipated

d) A gracilis free flap would not yield good facial function due to the location of the lesion

[Answer will be posted with next week's new question]

Answer to last week's question, “Simple Becomes Complicated” (May 25, 2020)

D - Reposition the stapes in the oval window and administer IV steroids