Non-small Cell Lung Cancer (NSCLC) Presenting as Isolated Facial Nerve Palsy from Metastasis to Temporal Bone: A Report Discussing Unique Presentation and Evolution with Diagnostic and Management Dilemmas

We present the case of a 67-year-old man with a three month history of right sided facial nerve palsy reporting to our clinic for evaluation of a recently seen suspicious mass in the right lung. Subsequently he was diagnosed with advanced NSCLC right lung and started on palliative chemotherapy. Furthermore, temporal bone metastasis was discovered on radiological imaging while investigating symptoms of acute mastoiditis and persisting facial neuralgia, a symptom completely overlooked at first as Idiopathic Bell's palsy. This presentation is exceptionally unique, although temporal bone metastasis arising from established primary lung or other malignancies is itself rare, and predilect to a later onset in the natural history of the disease, as reported in the literature. None of the published literature report neither addresses the optimal management course nor its subsequent impact on quality of life of patients with temporal bone metastasis.