FRCS (ORL-HNS) · SECTION 1 SBA

Perineural spread

A patient with recurrent temple cutaneous carcinoma develops progressive facial numbness and facial weakness. MRI shows enhancement tracking toward the skull base. What is the key interpretation?

CHOOSE ONE ANSWER

Best of five

  1. A. Simple postoperative neuropraxia
  2. B. Clinical and radiological perineural spread
  3. C. Bell palsy
  4. D. Trigeminal neuralgia
  5. E. Diabetic polyneuropathy
ANSWER AND REASONING

B. Clinical and radiological perineural spread

Progressive neuropathy in the distribution of named cranial nerves with enhancing proximal extension indicates perineural tumour spread, which changes resection fields, radiotherapy volumes and prognosis.

Why every option is right or wrong

A. Simple postoperative neuropraxia: Progression and proximal enhancement argue against transient injury.

B. Clinical and radiological perineural spread: Progressive neuropathy in the distribution of named cranial nerves with enhancing proximal extension indicates perineural tumour spread, which changes resection fields, radiotherapy volumes and prognosis.

C. Bell palsy: Sensory loss and known malignancy are red flags.

D. Trigeminal neuralgia: That causes episodic pain rather than progressive numbness and facial weakness.

E. Diabetic polyneuropathy: This would not track along a cranial nerve on MRI.

What if the scenario changed?

If weakness were acute, isolated and fully improving after surgery with no imaging abnormality, neuropraxia would be more plausible.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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