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      Postoperative Delayed Facial Nerve Palsy: A Surgeon's Nightmare

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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.
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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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              Predicting long-term facial nerve outcome after acoustic neuroma surgery.

              J Kwartler, W M Luxford, M Arriaga … (1993)
              Although anatomic preservation of the facial nerve is achieved in nearly 90% of reported cases after acoustic neuroma surgery, postoperative long-term facial function is of most concern to the patient. This study examines long-term facial nerve function in relation to the immediate postoperative function and the function at time of discharge from the hospital. Subjects included 515 patients who underwent primary acoustic neuroma removal at House Ear Clinic from 1982 through 1989 and who had normal preoperative facial function, an intact facial nerve after surgery, and a House-Brackmann facial nerve grade available immediately postoperatively, at time of hospital discharge, and at least 1 year postoperatively. Rate of acceptable facial function (House grades I-IV) differed significantly (p < or = 0.001) at the three postoperative time intervals: 85.2%, immediate; 73.6%, discharge; 93.8%, long-term. Of those with good immediate function (grades I-II), 98.6% had acceptable long-term function. Of those with poor immediate function (grades V-VI), 69.8% had acceptable long-term function. We conclude that facial nerve recovery after acoustic neuroma surgery is characterized by slight deterioration in the immediate postoperative period, but subsequent improvement in the long-term. Patients can be reliably counseled that acceptable function immediately after surgery is associated with a favorable long-term outcome; poor function immediately after surgery, despite an intact nerve, has a more guarded prognosis.
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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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