Delayed facial palsy after stapedectomy.

Abstract

OBJECTIVE:

To study the incidence, pathogenesis, and prevention of delayed facial palsy after stapedectomy.

STUDY DESIGN:

Retrospective case review.

SETTING:

Otology/neurotology referral center.

PATIENTS:

A series of 2152 stapedectomy procedures in 2106 patients over 12 years.

INTERVENTION:

Delayed facial palsy after stapedectomy was studied.

MAIN OUTCOME MEASURE:

House-Brackmann facial nerve grading system and serum antibody titer tests for herpes simplex virus type I and type II, and varicella zoster virus.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: J J Shea Jr, X Ge
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 22 Issue 4 Pg. 465-70 (Jul 2001) ISSN: 1531-7129 [Print] United States
• PMID: 11449101 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Aged
• Causality
• Facial Paralysis (diagnosis, epidemiology, virology)
• Female
• Geniculate Ganglion (virology)
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Risk Factors
• Simplexvirus (isolation & purification)
• Stapes Surgery
• Time Factors
• Trigeminal Ganglion (virology)