Intermittent facial spasms as the presenting sign of a recur
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The intimate anatomical relationship of the facial nerve to the parotid gland has a significant influence on the symptoms/signs, diagnosis, and treatment of parotid neoplasms. Involvement of the facial nerve by parotid malignancies usually results in partial or total hemifacial paralysis. However, to our knowledge, hyperactivity of this nerve presenting as facial spasm has not been reported as the presenting feature of a malignant parotid tumor. Facial spasm has nonetheless been reported twice in the literature as a presenting feature of a benign parotid tumor. We report a case of carcinoma arising in recurrent pleomorphic adenoma that presented with hemifacial spasms. We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.
This is a single institutional case report in a tertiary referral hospital. Institutional Review Board was not required to report one case at our institution.

Case Report:
A 56-year-old female smoker had a history of a pleomorphic adenoma in the left parotid gland treated with a superficial parotidectomy at the age of 18. Nineteen years following that surgery, the patient presented with multifocal recurrence. Surgical exploration was undertaken and the tumor was found inseparable from the facial nerve. At that time, the resection was abandoned and the facial nerve was not sacrificed and gross disease was left in the parotid bed. The patient underwent external beam radiation therapy and the size of the tumor remained stable for 10 years on serial computed tomography and magnetic resonance imaging monitoring. The patient had been clinically asymptomatic until she started developing intermittent ipsilateral hemifacial spasms occurring spontaneously and involving all portions of the left facial musculature, which prompted her to return for evaluation....