Transcanal resection of a type 1 glomus tympanicum

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To present a case of type 1 glomus tympanicum, its clinical presentations, surgical management and outcome.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Case Report<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> One<br /><strong>RESULTS:</strong> A 44-year-old woman with pulsatile tinnitus, vertigo, headache, ear fullness and decreased hearing on the right had a pulsatile reddish mass behind the tympanic membrane and Brown sign. Weber test lateralized to the right with mild conductive hearing loss on pure tone audiometry. Contrast CT scan demonstrated a 5x6 mm well-defined enhancing mass in the meso- and hypotympanum. Internal auditory canal MRI showed an avidly enhancing 5x3x4 mm nodule within the right middle ear adjacent to the cochlear promontory and anterior to the lateral semicircular canal. Impression was glomus tympanicum, type 1. The mass was excised via transcanal approach with post-operative resolution of tinnitus, headache, vertigo and improvement of hearing. Final histopathology was consistent with glomus tumor.<br /><strong>CONCLUSION:</strong> Glomus tympanicum tumors are rare, benign middle ear paragangliomas that arise from Jacobson's nerve are slow-growing and locally destructive. CT scan and MRI may detect involvement of other structures. Surgical resection is the primary treatment modality. Type 1 glomus tympanicum tumors are small and limited to the promontory and a less-invasive transcanal approach may be employed.</p>

Intraparotid facial nerve schwannoma with temporal bone extension

Objective@#To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment. @*Methods@#Design: Case Report Setting: Tertiary Government Hospital Patient: One @*Results@#A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy with facial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved. @*Conclusion@#A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.