A rare cause of facial nerve palsy

Introduction We present a case of a 69-year-old male who presented with a three-week history of left facial nerve palsy, serous-bloody otorrhea, otalgia and exposed necrotic bone at the floor of his ipsilateral ear canal.

His medical history revealed left canal wall down (CWD) mastoidectomy thirty years ago. Subsequently twenty years later a left sided squamous cell carcinoma of his tonsil was diagnosed for which he underwent curative chemo-radiotherapy. Seven years after his tonsil cancer, he started to complain of intermittent otalgia.

Investigations/Results History, typical clinical picture and comprehensive diagnostic workup including different imaging modalities and electrophysiology finally lead to a diagnosis of osteoradionecrosis of the temporal bone (ORNTB) with secondary facial nerve palsy. The facial nerve did not recover and treatment remained conservative as per patient’s preference.

Discussion/Conclusion ORNTB is a rare delayed complication after radiotherapy for head and neck cancer which occurs after about 8 years and a minimum of 41.8 Grey of radiation. Facial nerve palsy in ORNTB is rare with only 2.9% but in our particular case the patient had additionally undergone ipsilateral CWD mastoidectomy.

Different treatment options need to be personalized aiming at symptom control. There should be an awareness of the condition among ENT specialists, especially during head and neck cancer follow-ups, and in patients who have had mastoidectomy and subsequent radiotherapy affecting the ipsilateral temporal bone.

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Publication History

Article published online:
24 May 2022