Abstract:【Abstract】Objective: To analyze and discuss the clinical diagnosis and treatment strategies for facial neuroma, enhance understanding of the disease, and avoid misdiagnosis and mismanagement. Methods: The clinical data of 8 patients with facial neuroma treated in our department from September 2012 to December 2022 were retrospectively analyzed. Facial nerve function was graded using the House-Brackmann(H-B) system. Results: Among the 8 patients, 3 had a history of peripheral facial paralysis, and 7 presented with parotid gland masses. Only 3 patients with preoperative facial paralysis were correctly diagnosed with facial neuroma, while all 5 asymptomatic patients were misdiagnosed (1 as middle ear cholesteatoma and 4 as parotid tumors). Total tumor resection was performed in 3 patients with preoperative facial paralysis (H-B grade V-VI). One patient with grade V paralysis (duration <1 week) underwent concurrent facial-hypoglossal nerve anastomosis, achieving postoperative improvement to grade III. Tumor dissection in 4 parotid gland cases resulted in 1 grade I and 3 grade V facial nerve function. Partial tumor resection was performed in 1 case involving the intratemporal segment (tympanic portion), with postoperative nerve function preserved at grade I. Tumors were located in the extratemporal segment (parotid region, 5 cases), intratemporal segment (1 case), and both segments (2 cases). Postoperative pathology confirmed 6 schwannomas and 2 neurofibromas. Conclusion: Facial neuroma often presents with nonspecific symptoms and is prone to misdiagnosis in asymptomatic patients. Deep parotid lobe masses should raise suspicion of facial neuroma, and preoperative high-resolution imaging is critical for localization and characterization. Preoperative H-B grading is pivotal for surgical planning, with intraoperative decisions balancing tumor resection and nerve preservation. Long-term postoperative follow-up is essential to mitigate recurrence risks.
