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Cranial nerve palsy is a diagnostic guiding symptom in otolaryngology.. The differential diagnosis includes a variety of diseases, including head- and neck oncology. With a patient history and physical examination, cranial nerves are easy to examine. Unrecognized cranial nerve pathology can be associated with an infaust outcome.
A 65-year old woman presented with otalgia to an otolaryngologist, who diagnosed an external otitis. After treatment the complaints persisted and the patient was referred to our university medical centre. An intraoral parapharyngeal and pre-auricular swelling was seen. Histological examination proved a pleiomorfic adenoma of the deep lobe of the parotid gland. Physical examination after the biopsy showed a facial nerve (VII) and trigeminal nerve (V) palsy, which is an uncommon finding in benign pathology. Additional imaging showed a suspected malignant tumor with perineural growth. After resection of the parotid gland a carcinoma ex pleomorphic adenoma was diagnosed.
A 74-year old man visited his general practitioner with complaints of a headache for months and a ptosis of the left eye persistent for one week. The patient was referred to an otolaryngologist and ophthalmologist. Physical examination showed an optical nerve, oculomotor nerve, trochlear nerve and abducens nerve palsy, which suggested pathology located in the cavernous sinus or superior orbital fissure. Additional investigation showed an adenocarcinoma of the ethmoid sinus.
A 43-year old man visited his general practitioner with a facial nerve palsy. Physical examination showed a conductive hearing loss at the same side. After diagnostic imaging (CT-scan) followed by macroscopic radical resection and histological examination the diagnosis was known; a chondrosarcoma.
When a patient presents with cranial nerve pathology a patient history and physical examination has to be done, searching for an underlying cause. This will support the differential diagnosis and anatomical localization of the problem. Vice versa, if a patient presents with vague complaints or a lump in the head and neck area, examination of the cranial nerves has to be kept in mind. If oncology is suspected the patient should be referred to an otolaryngologist at a head- and neck oncologic centre, for additional imaging, staging and treatment.