Unusual presentation of progressive metastatic disease in temporal bone resulting in facial paralysis

Metastatic disease in temporal bones are extremely rare. Based on the location of metastatic disease, the symptoms can vary from incidental findings with no symptoms to hearing loss and facial weakness. When symptoms and signs co-relate it will not be difficult for clinical diagnosis. When symptoms and signs are intermittent, investigation does not support clinical diagnosis. It will be extremely difficult to manage a patient symptoms and their expectations, especially when there are no signs to support clinical symptoms during consultation. We present a rare case of very small metastatic deposit in temporal bone causing facial palsy, which only became evident over few weeks and diagnosis was only possible with surgical exploration.