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Peripheral facial paralysis is the partial or complete loss of the function of facial muscles on the affected side. Peripheral facial paralysis is extremely rarely associated with a benign process of parotid gland, so this must be clarified using topographical diagnostics. A 73-year-old patient with a known surgically treated Renal cell carcinoma presented with swelling in the area of parotid gland and accompanying left-sided facial palsy (HB-level IV) that had been occurring for about 10 days. After outpatient antibiotics and prednisolone therapy, the patient was sent and admitted to our clinic due to persisting symptoms. Sonography and magnetic resonance revealed a large, cystic, intraparenchymatous mass in the area of the leftparotid gland. Based on the anamnesis, a metastasis of renal cell carcinoma was suspected, so a large Ultrasound guided needle biopsy of the mass was performed. Histologically, a malignant process could not be reliably ruled out. As a result, after the inflammation had subsided and the symptoms persisted, was decided to perform a left-sided lateral parotidectomy. The cystic mass was completely removed intraoperatively. Histological analysis revealed compatibility with a Warthin tumor. Postoperatively, the peripheral facial paralysis slowly regressed. A mass in the parotid gland with simultaneous peripheral facial palsy always initially suggests a malignant process. Therefore, diagnostics and therapy should be adapted to this suspicion until exluding a malignant process through Histology or/and resolution of the palsy.
Hassounah et al. (Fri,) studied this question.