Prolonged peripheral facial nerve paralysis in a child — think of temporal bone rhabdomyosarcoma: case report

Rhabdomyosarcoma is the most common type of soft tissue sarcoma in childhood. When localized in the middle ear and temporal bone, they are highly aggressive, whereas the outcome directly depends on an accurate and timely diagnosis, stage of the disease, and adequate multimodal therapy. Early clinical diagnosis of the temporal bone rhabdomyosarcoma is often difficult since clinical signs are not specific for this disease. We present a case of an embryonal rhabdomyosarcoma, botryoid subtype, of the middle ear in a girl aged 4 years and 4 months, diagnosed 34 days after the first symptoms — right ear pain with peripheral facial nerve palsy on the same side. The overall symptoms were poor, in no way suggesting such a serious condition. After the treatment, control follow-ups for more than 3 years showed no recurrence of the disease, while signs of the right peripheral facial palsy persist.ConclusionIn cases of prolonged peripheral facial nerve palsy in children, not responding to conservative treatment, a temporal bone rhabdomyosarcoma should be considered in a differential diagnosis.