Delayed post‐stapedectomy facial paralysis: A report of five cases

Review of a series of 2,307 stapedectomy procedures revealed five cases of delayed facial paralysis. The paralysis was clinically complete in three and incomplete in two cases. Onset of weakness occurred from five to 13 days postoperatively. Complete recovery occurred in all cases within eight weeks and surgical intervention was unnecessary. The cause of this uncommon complication is felt to be retrograde edema of the chorda tympani nerve into the facial trunk, or edema of a dehiscent facial nerve in the postoperative period. This phenomenon has not been stressed in the otologic literature to date. Careful evaluation of the patient, close follow‐up with nerve excitability testing in cases of complete paralysis, and steroid and vasodilator therapy is the recommended mode of management. Exploration and decompression of the facial nerve should be strongly considered if the nerve excitability threshold exceeds that of the normal side by 3.5 ma. or more, or should the stimulus threshold be lost altogether. With preservation of nerve excitability thresholds, the outlook for return of function is good, according to this small series.