Delayed facial palsy following uneventful middle ear surgery: a herpes simplex virus type 1 reactivation?
In rare cases, a facial palsy appears a few days after uneventful middle ear surgery. The reason for this delayed palsy is unclear. One hypothesis is that it results from a reactivation of herpes simplex virus type 1 (HSV-1) in the geniculate ganglion of the facial nerve. From 1987 to 1996, in the course of over 1,800 middle ear operations, we observed 7 ipsilateral delayed facial palsies and investigated 5 of them using immunologic and virologic methods, including the polymerase chain reaction (PCR). We could detect HSV-1 genome with the nested primer PCR in the tongue swabs of 4 of the 5 examined patients with delayed facial palsy. The immunologic changes in these palsies are also compatible with a reactivation of HSV-1. We conclude that minimal stimulation of the facial nerve during middle ear surgery could result in a reactivation of HSV-1 in the geniculate ganglion, which may in turn lead to a facial palsy.
Bonkowsky
V
V
Department of Otolaryngology, University Clinic Regensburg, Germany.
Kochanowski
B
B
Strutz
J
J
Pere
P
P
Hosemann
W
W
Arnold
W
W
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D016516:CD4-CD8 Ratio; D018414:CD8-Positive T-Lymphocytes / Q000502:physiology; D004432:Ear, Middle / Q000601:surgery*; D005158:Facial Paralysis / Q000821:virology*; D005260:Female; D016679:Genome, Viral; D006561:Herpes Simplex / Q000150:complications* / Q000821:virology; D006801:Humans; D008213:Lymphocyte Activation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D018139:Simplexvirus / Q000235:genetics / Q000276:immunology / Q000502:physiology; D013997:Time Factors; D014775:Virus Activation / Q000502:physiology
D000914:Antibodies, Viral