Machado RA, Moubayed SP, Khorsandi A, Hernandez-Prera JC, Urken ML. Intermittent facial spasms as the presenting sign of a recurrent pleomorphic adenoma. World J Clin Oncol 2017; 8(1): 86-90 [PMID: 28246588 DOI: 10.5306/wjco.v8.i1.86]
Corresponding Author of This Article
Rosalie A Machado, Research Associate, Thyroid Head and Neck Cancer Foundation, 10 Union Square E, New York, NY 10003, United States. rmachado@thancfoundation.org
Research Domain of This Article
Otorhinolaryngology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Feb 10, 2017; 8(1): 86-90 Published online Feb 10, 2017. doi: 10.5306/wjco.v8.i1.86
Intermittent facial spasms as the presenting sign of a recurrent pleomorphic adenoma
Rosalie A Machado, Sami P Moubayed, Azita Khorsandi, Juan C Hernandez-Prera, Mark L Urken
Rosalie A Machado, Sami P Moubayed, Mark L Urken, Thyroid, Head and Neck Cancer Foundation, New York, NY 10003, United States
Rosalie A Machado, Sami P Moubayed, Mark L Urken, Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY 10003, United States
Azita Khorsandi, Department of Radiology, Mount Sinai Beth Israel, New York, NY 10003, United States
Juan C Hernandez-Prera, Department of Pathology, Mount Sinai Beth Israel, New York, NY 10003, United States
Author contributions: Urken ML designed the report; Machado RA, Moubayed SP, Khorsandi A and Hernandez-Prera JC wrote the manuscript; Urken ML made final edits to the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Mount Sinai Beth Israel in New York.
Informed consent statement: This case report was exempt from obtaining informed consent based on Institutional Review Board standards at Mount Sinai Beth Israel in New York.
Conflict-of-interest statement: All the authors have no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rosalie A Machado, Research Associate, Thyroid Head and Neck Cancer Foundation, 10 Union Square E, New York, NY 10003, United States. rmachado@thancfoundation.org
Telephone: +1-212-8446441 Fax: +1-212-8448465
Received: October 27, 2016 Peer-review started: October 28, 2016 First decision: December 1, 2016 Revised: December 17, 2016 Accepted: January 2, 2017 Article in press: January 3, 2017 Published online: February 10, 2017
Abstract
The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms. However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy. We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland (i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms. We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology. Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies. To date the development of facial spasm has not been reported with parotid malignancies. The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle (termed primary or idiopathic) (62%), hereditary (2%), secondary to Bell’s palsy or facial nerve injury (17%), and hemifacial spasm mimickers (psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm) (17%). Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.
Core tip: This report represents the first case of hemifacial spasm associated with transformation of a recurrent pleomorphic adenoma into a carcinoma ex pleomorphic adenoma. The causation of hemifacial spasms is discussed.
