Clinical Analysis of Delayed Facial Nerve Palsy after Middle Ear Surgery

Chang, Sun O; Hwang, Chan Ho; Koo, Ja Won; Oh, Seung Jun; Lee, Sang Joon; Seong, Weon Jin; Jung, Ha won; Yu, Won Seok; Kim, Chong Sun

Abstract

BACKGROUND AND OBJECTIVES: Delayed facial nerve palsy (DFNP) following a middle ear surgery is an uncommon event, and is defined to develop 48 or 72 hours after surgery. The pathogenesis of DFNP is not known clearly, but it is presumed to inflammation, neuronal edema or reactivation of herpes virus. The purposes of this study were to provide the clinical aspect of DFNP after middle ear surgery and to discuss the prognostic factors and treatment plan. MATERIAL AND METHOD: From January 1985 to August 1999, in the course of over 5,670 middle ear surgeries, we experienced 12 ipsilateral delayed facial nerve palsies. We analyzed the course of DFNP according to several clinical factors retrospectively. Degree of facial palsy was evaluated with the House-Brackmann grade (HBG).
RESULTS
DFNP was developed from 3 day to 14 day after middle ear surgery. The initial degree of facial palsy was HouseBrackmann grade (HBG) II in 6, HBG III in 4, and HBG IV in 2 patients. All patients were treated with steroid and volume expander. The final recovery were HBG I in 11 of the twelve patients. Remaining one patient was found to be HBG Il after a 5-year follow up. In the group who recovered within 1 month, the initial HBG were II or III.
CONCLUSION
We obtained satisfactory results with steroid therapy in most patients. The courses of DFNP after middle ear surgery are favorable. The better initial HRG and HBG at 2 weeks are, the earlier recovery can be expected.