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Facial Nerve Palsy is mostly idiopathic in nature. Every patient with a facial nerve Paralysis needs to go under through investigation, most importantly imaging to exclude other causes such as neoplasms. In very rare cases, the normal imaging results may be misleading and occult tumor or perineural spread along the nerve may not be detectable. Luckily these cases may present with alarming signs such as progressiveness nature associated with pain, complete Paralysis with no recovery and most importantly a history of regional skin cancer. These signs, when correctly interpreted, warrant for surgical exploration and biopsy avoiding misdiagnosis in patients with occult malignancy. We present a case report of a patient who initially diagnosed as idiopathic facial nerve Palsy which later turned to have a perineural invasion with occult metastasis of squamous cell carcinoma of the skin in the parotid gland as well as a review of the literature reporting similar cases. *Corresponding author: Dr. Mohammed Alghamdi, Department of Otolaryngology-Head and Neck Surgery, Augsburg University Hospital, Sauerbruchstrasse 6, 86179 Augsburg, Germany CASe RepoRT

Facial Nerve Palsy, When Should We be Alarmed: A Case Report of Facial Nerve Paralysis Caused by Occult Malignancy and Review of the Literature