{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:46:51Z","timestamp":1792176411798,"version":"4.4.0"},"reference-count":18,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,7,23]],"date-time":"2023-07-23T00:00:00Z","timestamp":1690070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001171","name":"Cancer Institute NSW","doi-asserted-by":"publisher","award":["CINSW2020\/2081"],"award-info":[{"award-number":["CINSW2020\/2081"]}],"id":[{"id":"10.13039\/501100001171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100024053","name":"Sydney Local Health District","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100024053","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Perineural spread (PNS) of head and neck cutaneous squamous cell carcinoma (HNcSCC) is a unique diagnostic challenge, presenting with insidious trigeminal (CN V) or facial nerve (CN VII) neuropathies without clinically discernible primary masses. These patients are often sub\u2010optimally investigated and misdiagnosed as Bell's palsy or trigeminal neuralgia. This case series highlights the red flags in history and pitfalls that lead to delays to diagnosis and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective case series of 19 consecutive patients with complete clinical histories with HNcSCC PNS without an obvious cutaneous primary lesion at time of presentation to a quaternary head and neck centre in Australia were identified and included for analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen had CN VII PNS, 17 had CN V PNS, and 13 had both. The overall median symptom\u2010to\u2010diagnosis time was 12\u2010months (IQR\u201015\u2009months). Eight patients had CN VII PNS and described progressive segmental facial nerve palsy with a median symptom\u2010to\u2010diagnosis time of 9\u2010months (IQR\u201011.75\u2009months). Eleven patients had primary CN V PNS and described well localized parathesia, formication or neuralgia with a median symptom\u2010to\u2010diagnosis time of 19\u2010months (IQR 27.5\u2009months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PNS is often mistaken for benign cranial nerve dysfunction with delays in diagnosis worsening prognosis. Red flags such as progressive CN VII palsy or persistent CN V paraesthesia, numbness, formication or pain, particularly in the presence of immuno\u2010compromise and\/or a history of facial actinopathy should raise suspicion for PNS. Gadolinium\u2010enhanced MR Neurography should be obtained expediently in patients with persistent\/progressive CN V\/CN VII palsies in patients with red flags, with low threshold for referral to a Head and Neck Surgeon.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18625","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T05:25:43Z","timestamp":1690176343000},"page":"2394-2401","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Persisting facial nerve palsy or trigeminal neuralgia \u2013 red flags for perineural spread of head and neck cutaneous squamous cell carcinoma (<scp>HNcSCC<\/scp>)"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7946-8874","authenticated-orcid":false,"given":"Michael","family":"Zhang","sequence":"first","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8487-9371","authenticated-orcid":false,"given":"Daniel","family":"Phung","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2940-313X","authenticated-orcid":false,"given":"Ruta","family":"Gupta","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Wykes","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9868-3767","authenticated-orcid":false,"given":"Raymond","family":"Wu","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8844-3444","authenticated-orcid":false,"given":"Jenny","family":"Lee","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Sydney Medical School, Faculty of Medicine and Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5654-2114","authenticated-orcid":false,"given":"Michael","family":"Elliott","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck 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Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8958-736X","authenticated-orcid":false,"given":"Tsu\u2010Hui (Hubert)","family":"Low","sequence":"additional","affiliation":[{"name":"Sydney Head and Neck Cancer Institute Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health University of Sydney  Sydney New South Wales Australia"},{"name":"Department of Otolaryngology, Head and Neck Surgery Macquarie Medical School, Macquarie University  Sydney New South Wales 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