Processed Allograft: Novel Use in Facial Nerve Repair after Resection of a Rare Racial Nerve Paraganglioma

To present a rare case of facial nerve paraganglioma and novel use of a processed allograft for facial nerve reconstruction. Case report and review of the literature. A 34 year old female presented with progressive onset right sided facial palsy for 5 months. CT and MRI demonstrated an irregular mass in the right facial nerve canal from the intratympanic segment to the stylomastoid foramen. Following transmastoid resection, the defect was repaired using processed allograft. Pathologic analysis was consistent with a paraganglioma. Facial nerve paraganglioma is a rare entity that has been reported only 10 times in the literature. Traditional methods of facial nerve reconstruction, including autologous and cadaveric grafting, can lead to significant patient morbidity. Autologous nerve grafts are the "gold standard" for superior regenerative capability, but are limited by the length and potential neuroma formation at the donor site. Allogenic grafts from donors or cadavers have shown some efficacy, but can require immunosuppression. The Avance nerve graft is a cadaveric graft, processed and decellularized to maintain an extracellular matrix with laminin and intact endoneural tubes, thus providing support for the growing axon without generating an immune response. Initial studies of the Avance graft in animals and humans have examined repair of peripheral nerves, but this is the first reported case of human facial nerve reconstruction.