In a series of 2,261 patients with parotid tumors, peripheral facial nerve paralysis developed spontaneously in 46 patients. These 46 patients all had malignant parotid tumors, which implies that facial nerve paralysis must be considered as a criterion of malignancy. The correlation between the incidence of this symptom and the grade of malignancy of the different types of parotid tumors has been settled. As all patients with malignant parotid tumors and concomitant facial nerve paralysis died of the tumor disease regardless of the radicality of the surgery, it seems that a tumor invading the facial nerve is beyond our present therapeutic procedures. In six patients the facial nerve paralysis was the first and only symptom of the malignant parotid tumor, which implies that an occult malignant parotid tumor always must be taken into consideration in patients with spontaneously developing peripheral facial nerve paralysis.
Eneroth C. Facial Nerve Paralysis: A Criterion of Malignancy in Parotid Tumors. Arch Otolaryngol. 1972;95(4):300–304. doi:10.1001/archotol.1972.00770080494002
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