A Case of Nasopharyngeal Carcinoma Presenting with Facial Paralysis

Nasopharyngeal carcinoma typically presents with neurological complications, notably trigeminal and abducens nerve palsy. However, facial nerve palsy is a rare occurrence, with only a limited number of reports until date. Herein, we report the case of an 80-year-old male patient with nasopharyngeal carcinoma who first presented with symptoms of facial nerve paralysis. Initially, he presented with right eye discomfort and had received treatment for Bell’s palsy before he was referred to our department. Clinical examination revealed a Yanagihara paralysis score of zero, and otoscopic examination revealed tympanic membrane pulsation with effusion. Imaging examinations confirmed extensive bone destruction and neoplastic infiltration from the nasopharynx to the skull base. Endoscopic examination revealed ulceration around the Eustachian tube, and histopathology confirmed the diagnosis of nasopharyngeal carcinoma (adenocarcinoma). The facial paralysis was hypothesized as having been caused by tumor extension through anatomical structures (Eustachian tube, carotid artery duct, or sinus of Morgagni). This case emphasizes the importance of otological evaluation in the differential diagnosis of patients presenting with facial paralysis.