Abstract
Objective
To analyze potential etiology and outcomes of delayed facial palsy (DFP) after tympanomastoid surgery.
Methods
Fifteen cases of DFP out of 1582 cases after tympanomastoid surgery were reviewed, and the potential causes and outcomes were analyzed.
Results
9 out of 15 patients (60%) had fallopian canal dehiscence and facial nerve exposure in contrast to 323 of 1567 patients (20.6%) without DFP, with significant difference (P < 0.01). Chorda tympani was cut or overstretched in 4 cases. There were two cases with herpes labialis and IgM antibody against varicella-zoster virus. All patients fully recovered within two months.
Conclusion
Fallopian canal dehiscence and facial nerve exposure was a risk factor of DFP after tympanomastoid surgery, and chorda tympani injury and viral reactivation may be triggering factors of DFP. The outcomes DFP after tympanomastoid surgery were excellent.
1
Introduction
Delayed facial palsy (DFP) after tympanomastoid surgery is uncommon in clinical practice. Its incidence varies greatly in different reports due to various enrollment criteria and definition of DFP, ranging from 0.38% to 1.4% . Different from DFP after vestibular schwannomas , the information about larger case series of DFP after tympanomastoid surgery is rather limited. This study enrolled 15 patients of DFP after tympanomastoid surgery, and aimed at discussing its possible etiology and outcomes.
2
Materials and methods
2.1
Patients
A consecutive series of 15 cases who had DFP after tympanomastoid surgery were selected between January, 2003 and January, 2012 among 1582 cases who underwent tympanomastoid surgery. DFP was defined as onset of facial palsy 48 hours after surgery. There were 6 males and 9 females. The mean age was 43.6 years (range, 17–68 years). Their clinical characteristics were collected and analyzed.
2.2
Surgical methods
Among the 9 patients with cholesteatoma otitis media, radical mastoidectomy was performed in 5 patients, and modified mastoidectomy was carried out in 4. Among the other 6 patients who had chronic suppurative otitis media, 3 patients had attic sclerotic lesions and lesions around ossicular chain removed due to tympanosclerosis followed by myringoplasty, and 3 underwent ossicular chain exploration and reconstruction as well as myringoplasty. Fallopian canal exploration was performed in all cases.
2.3
Treatment
Oral prednisolone tablets were provided soon after facial palsy, 1 mg/(kg day), once per day, for 5 days. Then, the dose was reduced by 10 mg every two days. For the two cases with herpes labialis, acyclovir was also prescribed.
2.4
Statistical analysis
Chi-square test was employed to compare the difference in incidence of fallopian canal dehiscence, and SPSS 16.0 software was used. P < 0.05 indicated that the difference was statistically significant.
2
Materials and methods
2.1
Patients
A consecutive series of 15 cases who had DFP after tympanomastoid surgery were selected between January, 2003 and January, 2012 among 1582 cases who underwent tympanomastoid surgery. DFP was defined as onset of facial palsy 48 hours after surgery. There were 6 males and 9 females. The mean age was 43.6 years (range, 17–68 years). Their clinical characteristics were collected and analyzed.
2.2
Surgical methods
Among the 9 patients with cholesteatoma otitis media, radical mastoidectomy was performed in 5 patients, and modified mastoidectomy was carried out in 4. Among the other 6 patients who had chronic suppurative otitis media, 3 patients had attic sclerotic lesions and lesions around ossicular chain removed due to tympanosclerosis followed by myringoplasty, and 3 underwent ossicular chain exploration and reconstruction as well as myringoplasty. Fallopian canal exploration was performed in all cases.
2.3
Treatment
Oral prednisolone tablets were provided soon after facial palsy, 1 mg/(kg day), once per day, for 5 days. Then, the dose was reduced by 10 mg every two days. For the two cases with herpes labialis, acyclovir was also prescribed.
2.4
Statistical analysis
Chi-square test was employed to compare the difference in incidence of fallopian canal dehiscence, and SPSS 16.0 software was used. P < 0.05 indicated that the difference was statistically significant.
3
Results
All of the 15 patients had chronic otitis media with a mean course of 22.9 years (range, 2–41 years). DFP occurred on days 2–14 after the surgery (mean, 4.4 days). Facial palsy reached the peak within 72 hours, and facial nerve function was HB Grade II-III during the peak period. Among the 15 patients, 2 patients had herpes labialis and serological test demonstrated the presence of IgM antibody to varicella-zoster virus.
During the surgery, fallopian canal dehiscence at horizontal segment of facial nerve with exposure of facial nerve was noticed in 9 of 15 cases (60%) with DFP. In contrast, fallopian dehiscence was found in 323 of 1567 patients (20.6%) without DFP, with significant difference (P < 0.01). The remaining 6 cases had intact fallopian canal, of which chorda tympani was cut in two cases, and overstretched in two cases, too.
After treatment of DFP, all patients recovered completely without sequelae, among which 8 patients fully recovered within 10 days, 6 patients returned to normal level within 20 days and one patient backed to Grade I 45 days later.
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