Immediate facial nerve palsy following stapedectomy

Iatrogenic facial nerve palsy following stapedectomy is a rare but devastating complication. The authors describe a case of a 20-year-old man who presented for legal advice concerning an immediate facial nerve palsy following a left stapedectomy. The incidence, management and prognosis of such injuries are discussed.     

Delayed facial nerve palsy following uneventful stapedectomy

Facial nerve palsy is a rare complication of stapedectomy. Its onset may be immediate or delayed by several days. The authors present a case of a 59-year-old man who developed right delayed peripheral facial nerve palsy occurring after uncomplicated ipsilateral stapedectomy. The incidence, treatment and prognosis of this complication are discussed.     

Prediction of facial nerve function following acoustic neuroma resection using intraoperative facial nerve stimulation

Methods of monitoring the facial nerve during posterior fossa surgery continue to evolve. In an effort to predict acute and final facial nerve function following acoustic neuroma resection, the lowest current applied to the facial nerve at the brainstem necessary to elicit facial muscle response was measured using strain gauge and electromyographic facial nerve monitors. A retrospective analysis of 121 patients who had undergone acoustic neuroma surgery was performed. Sixty-five patients had intraoperative facial nerve monitoring and 44 had sufficient data for inclusion in this study. The acute and final facial nerve functions, according to the House-Brackmann classification, were assessed with regard to intraoperative stimulation-current thresholds. Nineteen of 20 patients who required 0.10 mA or less to elicit a facial muscle response had a House-Brackmann grade I facial nerve outcome. The upper limit of the 95% confidence interval of stimulation threshold for patients with a final grade I facial nerve function is 0.17 mA. All of the patients in this study, with stimulation thresholds ranging up to 0.84 mA, had a final grade III or better result. A poor outcome in our series, a final grade III facial nerve function, is best predicted by a poor acute result, specifically an acute grade VI_A facial nerve function. We suggest that it is possible to predict the facial nerve function based on intraoperative threshold testing.     

Rehabilitation of facial nerve palsy

Forty-nine patients underwent 158 procedures (including 19 revisions) for complete facial palsy. The variety of causes of facial palsy are enumerated, with the various procedures used to rehabilitate the face. Some improvement is invariably achieved. It is concluded that a readiness to intervene with a wide choice of procedures as early as realistically possible offers the best outcome in function and cosmetic appearance.     

Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy

Facial synkinesis and asymmetry commonly impair the outcome of facial nerve palsy. Botulinum toxin type A is a neurotoxin which prevents acetylcholine release at the neuromuscular endplate, paralysing skeletal muscle. This paper examines its use in 24 patients with synkinesis and asymmetry affecting the eye and mouth. Sixty-eight of 72 treatments produced improved cosmesis. Dose-related complications occurred in 26 treatments but were generally mild and transient. The total dosages of toxin used were analysed. The higher dose group compared with the lower dose group had no significant advantage in overall cosmetic improvement but the complication rate was significantly higher in the higher dose group (20/39) compared with the lower dose group (6/33) (X² 6.675, P>0.05).     

Delayed facial palsy following laser stapedectomy: in vitro study of facial nerve temperature

Delayed facial palsy following conventional stapes surgery is a rare event, but this complication appears to be more common when a laser is used. We have investigated the temperature in the facial canal during stapes surgery using a KTP laser or a microdrill in preserved human temporal bones. Thermocouples were placed in the facial canal and under the foot plate. The results show maximum rises in temperature of between 1.4 degrees C and 15.2 degrees C in the facial canal during laser surgery (mean 6.1 degrees C, SD 4.5 degrees C), but only between 0.45 degrees C and 2 degrees C during procedures in which a microdrill was used (mean 0.9 degrees C, SD 0.9 degrees C) (P = < 0.009). In addition, the facial nerve undergoes repeated heating and cooling cycles during the laser surgery. We conclude that heating of the facial nerve during laser surgery causes oedema, which in turn leads to compression of the nerve within its bony canal.     

Bilateral simultaneous facial nerve palsy

Bilateral simultaneous facial nerve palsy is an extremely rare clinical entity with Bell's palsy responsible for a mere 20 per cent of cases. It is, therefore, important that clinicians are aware of the differential diagnosis when evaluating a case.     

Rehabilitation of facial nerve palsy.

Forty-nine patients underwent 158 procedures (including 19 revisions) for complete facial palsy. The variety of causes of facial palsy are enumerated, with the various procedures used to rehabilitate the face. Some improvement is invariably achieved. It is concluded that a readiness to intervene with a wide choice of procedures as early as realistically possible offers the best outcome in function and cosmetic appearance.     

Management of peripheral facial nerve palsy

Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell's palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell's palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell's palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell's palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell's palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae.     

Recurrent facial nerve palsy on flying

We report a case of a patient who experienced transient recurrent facial nerve palsies during flights on commercial aeroplanes. Although this condition is well recognized in divers, only six cases have been reported to occur on flying. The pathophysiology of this condition is discussed.     

Differential diagnosis of facial nerve palsy.

The differential diagnosis of facial complex can be complex, but all efforts must be made to identify the cause so that appropriate treatment can be offered. This article presents a review of conditions associated with acute facial palsy and discusses the differential diagnosis of this condition. The focus is on the differentiation of other causes of acute facial palsy from the idiopathic, or Bell's type, which is a diagnosis of exclusion.     

Delayed facial palsy following uncomplicated stapedectomy

We report six cases of partial lower motor neurone facial palsy occurring between four and ten days after uncomplicated stapedectomy. The aetiology is unclear but recovery was rapid and complete in all patients.     

Delayed facial nerve palsy after otologic surgery

Delayed facial nerve palsy (DFP) is rarely experienced after otologic surgeries that do not directly touch the facial nerves, such as tympano-mastoidectomy, cochlear implants, and stapes surgery, and is troublesome to both surgeons and patients if it happens. Here, we report 7 cases of DFP, including one case that developed DFP after endolymphatic sac surgery. The ratios of occurrence were as follows: 0.7% (2/305) for tympano-mastoidectomy, 0.8% (3/354) for cochlear implant, 0.4% (1/260) for stapes surgery and 1.0% (1/98) for endolymphatic sac surgery. All otologic surgeries, except for endolymphatic sac surgery, exposed the chorda tympani, and all surgeries, except for stapes surgery, underwent drilling for a mastoidectomy. Furthermore, DFP was always observed ipsilaterally to the operated ear after otologic surgeries and was never seen after benign parotid tumor surgery or total laryngectomy. Therefore, there may be a strong relationship between DFP and the procedures, used during otologic surgeries.