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Facial nerve palsy in mastoid surgery

Published online by Cambridge University Press:  29 June 2007

E. L. K. Nilssen  and
P. J. Wormald
E. L. K. Nilssen*
Affiliation:
Department of Otolaryngology, Groote Schuur Hospital, Observatory 7925, Cape Town, R.S.A.
P. J. Wormald
Affiliation:
Department of Otolaryngology, Groote Schuur Hospital, Observatory 7925, Cape Town, R.S.A.
*
Address for correspondence: Dr E. L. K. Nilssen, Department of Otolaryngology, Groote Schuur Hospital, Observatory, 7925, Cape Town, R.S.A.
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Abstract

The risk of facial nerve injury during mastoid surgery has decreased substantially since the advent of the microscope and the otological drill. However, the facial nerve remains at risk during mastoid surgery with the present day incidence suggested to be one per cent. Despite the severity of this complication there are no recent studies that accurately quantify the incidence or discuss its management. The aims of this study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a management protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 17 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only and recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follow-up and recovered to House Brackmann Grade 4 only. All the partial palsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brackmann Grade 2 or better. A management protocol followed for the above patients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively are also discussed.

Keywords

Facial nerve palsymastoid surgery
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 2 , February 1997 , pp. 113 - 116
Copyright
Copyright © JLO (1984) Limited 1997

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References

Cawthorne, T. (1946) Peripheral facial paralysis. Some aspects of its pathology. Laryngoscope 56: 653–665.CrossRefGoogle ScholarPubMed
Coker, N. J. (1991) Current issues in head and neck trauma. Management of traumatic injuries to the facial nerve. Otolaryngologic Clinics of North America 24(1): 215–227.CrossRefGoogle Scholar
Coker, N. J. (1993) Acute paralysis of the facial nerve. In Head and Neck Surgery – Otolaryngology (Bailey, J. B., ed), J. B. Lippincott Company, Philadelphia, pp 1711–1727.Google Scholar
Fisch, U. (1994) Tympanoplasty, Mastoidectomy, and Stapes Surgery. Thieme Medical Publishers, Inc., New York, pp 6.Google Scholar
Green, J. D. Jr., Shelton, C., Brackmann, D. E. (1994) Surgical management of iatrogenic nerve injuries. Otolaryngology – Head and Neck Surgery 111(5): 606–610.CrossRefGoogle Scholar
Jonsen, A. R. (1990) The New Medicine and the Old Ethics. Harvard University Press. Cambridge, Massachusetts, London, pp 23.Google Scholar
McCabe, B. F. (1973) Symposium on trauma in otolaryngology. Injuries to the facial nerve. Laryngoscope 82: 1891–1896.CrossRefGoogle Scholar
Schuring, A. G. (1988) Medicolegal otology: iatrogenic facial nerve palsy. American Journal of Otology 9(5): 432–433.Google Scholar
Shambaugh, G. E. Jr. (1959) Facial nerve decompression and repair. In Surgery of the Ear., W. B. Saunders Company, Philadelphia, Pa., p 546.Google Scholar