Syringocystadenoma Papilliferum in an Adolescent with Grade 3 Microtia and Facial Nerve Palsy: A Rare Case Report with Literature Review.

Syringocystadenoma Papilliferum (SCAP) is rare clinical entities with atypical presentation that lead to diagnostic challenges. We describe a case of a 13-year-old male who had foul-smelling right postauricular discharge for 4-month and progressive worsening of childhood-onset hearing loss. Examination revealed House-Brackmann grade I facial palsy on the right side and grade 3 microtia with mild conductive hearing loss. High-resolution computed tomography and magnetic resonance imaging of the temporal bone showed sclerosis of the right mastoid air cells along with inflammatory changes. Right tympanomastoid exploration revealed a mass in the right postauricular region, and histopathology confirmed the diagnosis. An abnormal course of the right facial nerve was present. The facial nerve was transected intraoperatively followed by reconstruction with a greater auricular nerve graft, which led to House-Brackmann grade V facial nerve palsy and improved gradually with physical therapy. Thus, SCAP should be a differential diagnosis in pediatric patients who present with postauricular discharge, microtia, and facial nerve palsy, to ensure timely surgery and favorable outcomes.