A 62-year-old man has a firm, fixed parotid mass of 6 months duration. He now develops complete ipsilateral facial weakness involving all branches. The most important implication of this finding is:
- A Malignant tumour until proven otherwise, requiring imaging and biopsy planning ✓
- B Benign pleomorphic adenoma undergoing cystic degeneration
- C Bell's palsy unrelated to the parotid mass
- D Chronic bacterial sialadenitis with perineural oedema
Correct answer: A. Malignant tumour until proven otherwise, requiring imaging and biopsy planning
Explanation
Facial nerve palsy associated with a parotid mass is an ominous sign of malignancy, since benign tumours displace rather than invade the nerve. It mandates contrast MRI and core biopsy or guided FNAC, and counselling for possible total conservative parotidectomy with nerve grafting. Pleomorphic adenoma and chronic sialadenitis do not cause nerve invasion, and attributing the palsy to Bell's palsy would dangerously delay diagnosis of carcinoma such as adenoid cystic or salivary duct carcinoma.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.