Objectives/Hypothesis: When facial neuromas are incidentally discovered or present with limited facial nerve dysfunction, they present a dilemma for the neurotologic surgeon. Excision of facial neuromas nearly always results in facial paralysis of House-Brackmann Grade III/VI or higher, even with primary nerve anastamosis or grafting, or if nerve fiber preservation is accomplished. Thus, when treating facial neuromas, wide decompression of the tumors should be considered as an alternative. This constitutes removing bone around the tumor and nerve both distal and proximal to the tumor, and it can lead to long-term preservation of function. This presentation reviews our experience with wide decompression of facial neuromas and discusses various treatment options. Study Design: We performed a retrospective review of patients with the diagnosis of facial neuroma between 2002 and 2007. Methods: Two patients had facial neuromas discovered intraoperatively during cholesteatoma removal. Two patients presented with facial nerve dysfunction. Wide decompression of the two facial neuromas discovered intraoperatively was performed during the procedure. One patient with extensive facial nerve dysfunction opted for excision and nerve grafting, while the other patient with facial paresis decided upon wide decompression. Results: Average follow-up was 38.5 months. Facial nerve function remained stable or improved in all patients. The three wide decompression patients maintained pre-operative speech reception thresholds, whereas the excision patient experienced a worsening of the SRT. Conclusions: Wide decompression should be considered as an option for patients with facial neuromas, especially those who have HB Grade I-III facial nerve function, wish to maintain hearing, or the lesion is diagnosed incidentally during surgery.
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