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


METHODS
Retrospective case review.


METHODS
Otology/neurotology referral center.


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


METHODS
Delayed facial palsy after stapedectomy was studied.


METHODS
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.
Shea
J J
JJ
Shea Ear Clinic, Memphis, Tennessee 38119, USA.
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D000328:Adult; D000368:Aged; D015984:Causality; D005158:Facial Paralysis / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D005260:Female; D005830:Geniculate Ganglion / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D018139:Simplexvirus / Q000302:isolation & purification; D013201:Stapes Surgery; D013997:Time Factors; D012668:Trigeminal Ganglion / Q000821:virology