Facial nerve lesion as a complication of cryodestruction for facial basal cell carcinoma

Background. Skin cancer is the most common malignant neoplasm which represents an important problem for modern health care. Published data show that the incidence is increasing over the past 50 years; by 3–10% annually. The prevalence of skin cancer depends on a number of factors: genetic, environmental influences, age, profession. Treatment options for basal cell skin cancer include surgery, radiation therapy, photodynamic therapy, local chemotherapy and immunotherapy, radio wave therapy, cryosurgery, laser therapy, and targeted therapy. Among them, cryosurgery is an effective, technically simple and inexpensive method of treatment available on an outpatient basis for a number of benign, precancerous and malignant skin tumors. However, the use of cryosurgery is accompanied by various complications.

Aim. To present a case of iatrogenic damage to facial nerve during cryosurgery for facial basal cell carcinoma.

Materials and methods. A 69-year-old patient who, in April 2019, was diagnosed with skin cancer of the left parotid region, stage I cT1N0M0, nodal variant at the regional oncological dispensary. Cytology showed basal cell carcinoma. The tumor, 1.6×2 cm in size, was located at the level of the earlobe. Cryodestruction was carried out by double freezing for 30 s, the thawing time was 60 s. During treatment and 7 days after treatment, the patient noted a sharp pain in the area of intervention, so he took analgesics. On the 8th day, the asymmetry of the face on the left, the drooping mouth and the inability to cover the eyes. The patient consulted a neurologist, he was diagnosed with facial nerve lesion on the left. For this disorder, the patient received conservative inpatient and outpatient treatment for a long time (several months), as a result of which some improvement was observed.

Results. Complete functional recovery did not occur. The wound healed under a scab, with oozing, for 8 weeks. A follow-up examination in April 2021 revealed a local recurrence in the area of the scar, and a cytological examination revealed a basal cell carcinoma.

Conclusion. This case indicates a possible risk of damage to the facial nerve at the site of its exit on the face during cryosurgical treatment for skin cancer in this area. When choosing a method of treatment, attention should be paid to the localization of the tumor, given critical anatomical zones.