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■ OBJECTIVES: The facial nerve paralysis caused by tumor require safe, adequate, and complete removal of the pathology as well of the immediate reparation of the related functional deficits. In facial nerve destruction in the internal auditory meatus, cooperation of otoneurosurgeon and neurosurgeon is rendered. Epidermoid of the inner auditory canal (IAC) and of the petrous bone is a rare pathology that grows slowly and is often asymptomatic for a long time. The initial treatment for symptomatic epidermoid of IAC and cerebro pontine angle (CPA) is surgical. If the facial nerve is found locally destroyed and discontinued, immediate anastomosis can be attempted.

■ METHODS: A 34-year old female patient was introduced to our tertiary center due to a year long history of sudden, total peripheral right facial paralysis, as the only symptom. The CT presented a bone destructive lesion, not well-defined, with attenuation values near that of cerebrospinal liquid, in the region of porus of IAC and its lateral part. The MRI imaging confirmed the epidermoid mass as well as the inflammatory response in the surrounding. Middle fossa approach was used for removal of the adherent matrix. The lesion entered the IAC where a few millimeters of the facial nerve were destructed. After the microscopically total removal of the cholesteatoma, the facial nerve was drilled out from its bony canal in the area for first genus and in the horizontal tympanic part. The medial part of the facial nerve was exposed in the medial part of IAC. After rerouting of the labyrinthine and tympanic part of the facial nerve, end-to-end anastomosis was performed.

■ RESULTS: No postoperative complications occurred. Follow up time is now one year and half. The MRI imaging shows no recurrence of the disease and in the last three months the recovery of the facial nerve function can be clinically seen.

■ CONCLUSIONS: TFacial nerve paralysis needs an adequate history-taking, detailed clinical examination with advanced imaging techniques. Cooperation of otoneurosurgeon and neurosurgeon enable immediate reparation of the tumor related functional deficits after safe, adequate and complete removal of the pathology in theIAC and CPA.