Facial Nerve Tumors(Schwannomas & Hemangiomas)
Precision surgical management and nerve reconstruction for tumors originating on the facial nerve.
What are Facial Nerve Tumors?
While Acoustic Neuromas and Parotid Tumors develop on adjacent structures and press against the facial nerve, some rare, benign (non-cancerous) tumors grow directly on the facial nerve itself. The two most common types are:
- Facial Nerve Schwannomas: These tumors arise from the Schwann cells, the insulating cells that wrap around and protect the nerve fibers. As the tumor slowly grows, it essentially balloons outward from the nerve trunk, stretching the nerve fibers across its surface.
- Geniculate Ganglion Hemangiomas: A collection of abnormal, extra blood vessels (a vascular tumor) that typically grows at a very specific juncture of the facial nerve behind the eardrum called the geniculate ganglion. Even when very small, these can cause severe facial weakness.
Because these tumors are intertwined with the actual nerve fibers, treating them presents a difficult paradox: the tumor must be managed, but surgically removing the tumor often requires cutting out that section of the facial nerve, resulting in complete facial paralysis.
The "Wait and Scan" Strategy
Because these tumors are benign and grow extremely slowly, surgery is not always the first step. If you still have good facial movement (even if the tumor has been identified on an MRI), Dr. Jowett often recommends a conservative approach of regular MRI monitoring.
Surgery is typically only recommended when facial function has severely deteriorated (becoming a permanent cosmetic and functional burden) or if the tumor begins to threaten your hearing or brainstem. Timing the surgery correctly is the most critical decision in managing facial nerve tumors.
Clinical Presentation
Symptoms often develop gradually and can be misdiagnosed for years.
Slow, Progressive Weakness
Unlike Bell's Palsy which happens overnight, weakness from a tumor typically worsens over months or years. It may fluctuate, getting slightly better and then worse again.
Facial Twitching (Spasms)
As the tumor irritates the nerve fibers, it can cause involuntary twitching or spasms (hemifacial spasm) on one side of the face.
Hearing Loss & Tinnitus
Because the facial nerve travels through the ear canal alongside the hearing nerve, large tumors can press against the ear structures, causing hearing loss or ringing.
Surgical Treatment & Reanimation
When a tumor must be removed, Dr. Jowett plans for immediate nerve reconstruction to restore function.
In most cases, the segment of the nerve harboring the tumor must be excised. During the same surgery, Dr. Jowett harvests a sensory nerve (often from the neck or leg) and microsurgically sews it in to bridge the gap. This allows the facial nerve to slowly grow back into the face over 6-12 months.
Why Choose Revitalis?
Dr. Nate Jowett is a world-renowned expert in facial reanimation. With dual fellowship training in Germany and at Harvard Medical School, he brings a unique engineering and microsurgical background to treating complex facial nerve disorders.
Whether you are days into a diagnosis or have lived with incomplete recovery for years, Dr. Jowett offers the full spectrum of care, from medical management to cutting-edge surgical reconstruction, to help you regain your smile and confidence.
Selected References
- Long-Term Vestibulocochlear Functional Outcome Following Retro-Sigmoid Approach to Resection of Vestibular Schwannoma. Abboud T, Jowett N, et al. Oper Neurosurg (Hagerstown). 2015 Jun;11(2):220-5. doi: 10.1227/NEU.0000000000000676. PMID: 25700833.
- A General Approach to Facial Palsy. Jowett N. Otolaryngol Clin North Am. 2018 Dec;51(6):1019-1031. doi: 10.1016/j.otc.2018.07.002. PMID: 30119926.