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      Postoperative Delayed Facial Nerve Palsy: A Surgeon's Nightmare

      case-report

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          Abstract

          The facial nerve supplies motor, sensory, and parasympathetic innervation to the head and neck, and its paralysis can have significant physical and psychological impacts. This study discusses a compelling case involving a 21-year-old male who developed delayed facial nerve palsy (DFNP) on the eighth day after cortical mastoid surgery. Through conservative management, the patient achieved a full recovery by the 52nd day. Our experience underscores the importance of approaching DFNP with patience, emphasizing the need for thorough counseling of both the patient and their family members.

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          Most cited references15

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          Delayed facial palsy after resection of vestibular schwannoma.

          In this study the authors investigate delayed facial palsy (DFP), which is an underreported phenomenon after surgery for vestibular schwannoma (VS). The authors identified 15 (4.8%) patients from a consecutive series of 314 who underwent surgery for VS between 1988 and 2000, and in whom DFP developed. Delayed facial palsy was defined as a deterioration of facial nerve function from House-Brackmann Grades 1 or 2 more than 3 days postoperatively.
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            Delayed facial palsy after middle-ear surgery due to reactivation of varicella-zoster virus.

            K Gyo, N Honda (1999)
            Viral reactivation is thought to be an important cause of post-operative facial palsy of delayed onset. We present an unusual case of Ramsay-Hunt syndrome that occurred as a consequence of middle-ear surgery by triggering varicella-zoster virus reactivation. As a pathognomonic auricular eruption was not seen, the patient was initially misdiagnosed as iatrogenic facial palsy. Clinical features, diagnosis and management are discussed.
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              Delayed facial palsy after stapedectomy.

              To study the incidence, pathogenesis, and prevention of delayed facial palsy after stapedectomy. Retrospective case review. Otology/neurotology referral center. A series of 2152 stapedectomy procedures in 2106 patients over 12 years. Delayed facial palsy after stapedectomy was studied. House-Brackmann facial nerve grading system and serum antibody titer tests for herpes simplex virus type I and type II, and varicella zoster virus. Delayed facial palsy occurred in 11 of 2152 procedures. Delayed facial palsy occurred from 5 to 16 days (mean 8) after stapedectomy. Predisposing factors were bony facial canal dehiscence with bare or bulging facial nerve herniation in 5 patients; chorda tympani nerve stretched, manipulated, or cut in 2 patients; granulomatous reaction to Gelfoam in 1 patient; fever blisters on the upper lip in 1 patient; and sinusitis in 2 patients. Elevated anti-varicella antibody titers were found in all 6 patients studied. Anti-herpes simplex type I and II antibody titers were elevated in 5 of 6 patients. Acyclovir was effective in preventing delayed facial palsy in 1 patient who had undergone revision stapedectomy and experienced delayed facial palsy after previous stapedectomy in the same ear with elevated anti-herpes antibody titer. Delayed facial palsy occurred in 0.51% of patients after stapedectomy. Serologic investigation suggests activation of latent herpesvirus. Mechanical irritation of the facial or chorda nerve during operation may trigger the activation. The anti-herpesvirus agent acyclovir may prevent delayed facial palsy after stapedectomy in patients suspected of having this complication.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                21 April 2024
                April 2024
                : 16
                : 4
                : e58691
                Affiliations
                [1 ] Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
                [2 ] Otolaryngology-Head and Neck Surgery, All India Institute of Medical Sciences, Bilaspur, Bilaspur, IND
                [3 ] Pharmacology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
                [4 ] Radiodiagnosis, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
                Author notes
                Article
                10.7759/cureus.58691
                11108257
                38774163
                8cae216f-0620-462f-996e-50276d33ed0d
                Copyright © 2024, Bano et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 April 2024
                Categories
                Otolaryngology

                csom: chronic suppurative otitis media,steroid treatment,postop complication,delayed facial nerve palsy,cortical mastoidectomy

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