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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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          Delayed facial palsy after resection of vestibular schwannoma.

          Gerald Grant, Robert Rostomily, D Kim … (2002)
          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.
          Article 0 comments Cited 8 times – based on 0 reviews     Review now
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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.
            Article 0 comments Cited 7 times – based on 0 reviews     Review now
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              Delayed facial palsy after stapedectomy.

              Steven X. Ge, Barbara Shea (2001)
              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
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 21 April 2024
                Publication date (Electronic, collection): April 2024
                Volume: 16
                Issue: 4
                Electronic Location Identifier: 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
                DOI: 10.7759/cureus.58691
                PMC ID: 11108257
                PubMed ID: 38774163
                SO-VID: 8cae216f-0620-462f-996e-50276d33ed0d
                Copyright © Copyright © 2024, Bano et al.
                License:

                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
                Date accepted : 21 April 2024
                Categories
                Subject: Otolaryngology

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

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