Facial numbness with or without pain suggests pathologic involvement of CN V, such as neoplastic processes that affect the nerve in the area of the cavernous sinus and the Meckel cave. Rapidly growing tumors, such as aggressive undifferentiated malignancies, may produce pain in a large percentage of patients. Facial cutaneous malignancy may be associated with perineural invasion and cause progressive pain, numbness, and multiple CN palsies. Patients should therefore be specifically questioned about prior facial malignancies. Orbital imaging may reveal enlargement of the inferior or superior orbital nerves; a biopsy of these nerves can confirm the diagnosis.
Excerpted from BCSC 2020-2021 series: Section 5 - Neuro-Ophthalmology. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.