A 50-year-old man presents with a hard palate mass and recent onset of numbness over the right cheek. Biopsy shows adenoid cystic carcinoma. The facial numbness in this context is most likely due to which mechanism?
- A Perineural spread along the maxillary nerve (V2) ✓
- B Direct extension into the infratemporal fossa
- C Metastatic deposits in the trigeminal (Gasserian) ganglion
- D Lymphatic obstruction of the facial nerve branches
Correct answer: A. Perineural spread along the maxillary nerve (V2)
Explanation
Adenoid cystic carcinoma has a well-documented propensity for perineural spread, which is a hallmark of the tumor and often the route of extension to the skull base. Numbness over the cheek corresponds to the maxillary nerve (V2) distribution, and perineural invasion along this nerve explains the symptom. Direct infratemporal fossa extension would present differently, and metastatic deposits in the Gasserian ganglion are not the typical mechanism for this presentation.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.