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Clinical Challenge
February 2016

A Mass Involving the Buccal Branch of the Facial Nerve

Author Affiliations
  • 1Department of Oral and Maxillofacial Surgery, KU Leuven, University Hospitals Leuven, Leuven, Belgium
  • 2Department of Pathology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
  • 3Department of Imaging and Pathology, OMFS IMPATH Research Group, Leuven, Belgium
JAMA Otolaryngol Head Neck Surg. 2016;142(2):187-188. doi:10.1001/jamaoto.2015.3077

A 14-year-old girl presented with an asymptomatic, painless, slowly growing, invisible but clearly palpable nodule in the left cheek. Apart from extrinsic asthma, her medical history was unremarkable. Clinical intraoral and extraoral examinations showed only a mobile, nontender, roundish, firm nodule, approximately 1 × 1 cm, embedded deep within the soft tissues of the left cheek, in the infraorbital region. Ultrasonography showed a nonspecific, superficial nodule with a central hyperreflective component. Vascularization was slightly increased (Figure, A). The lesion was excised surgically (approximately 1.5 × 1.5 cm) under general anesthesia, with an intraoral approach. During surgery, we noted marked vascularization and infiltration of surrounding motor nerve fibers. Despite careful dissection, it was not possible to spare all terminal fibers of the buccal branch of the facial nerve because these were extensively embedded in the lesion, resulting in a temporary facial nerve paralysis. The specimen was sent for histologic examination. After hematoxylin-eosin staining, light microscopy showed a septated, multilobular lesion with a myxoid stroma, cell nesting, and variable cellularity. The cells had small, round-to-ovoid, nonatypical nuclei, with eosinophilic cytoplasms (Figure, B). Immunohistochemical investigations showed no convincing expression of S-100 but rather a clear, diffuse, positive signal with NKI/C3 antibodies (Figure, C). Immunohistochemical stainings were negative for keratin, α-smooth muscle actin, epithelial membrane antigen, and desmin.

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