A rare case of plasma cell granuloma arising from facial nerve

We present a 38 year old male with a rare case of plasma cell granuloma arising from facial nerve which posed a diagnostic and therapeutic challenge. He has no other comorbidities except for a history of left ear modified radical mastoidectomy performed in 2002 for cholesteatoma after which he recovered uneventfully. This time he presented with mass in the ear canal with ear block and otorrhea for 1 month duration. Initial biopsy revealed granulation tissue. CT scan revealed bony destruction with soft tissue mass. Diagnosis of recurrence of cholesteatoma was made for which he underwent MRM under general anesthesia. Intraoperatively, there was soft tissue mass filling the mastoid and the middle ear and destruction of all ossicles. The mass was arising from facial nerve and there was bony dehiscence of facial nerve. The mass sent for histopathology revealed plasma cell granuloma. He recovered uneventfully with intact facial nerve and hearing level of 40 dB .Ear canal polyp should not be avulsed as it may arise from facial nerve and any mass should be subjected to histopathological examination and should not be left as granulation tissue. This case posed both diagnostic and therapeutic challenge and supported the hypothesis of that plasma cell granuloma are psudotumour and with proper excision and post-operative steroids, there will be complete remission.