Postoperative facial paralysis: The otologist's dilemma

This paper deals with the problems of postoperative facial paralysis complicating middle ear and mastoid surgery. The anatomy of the tympanic and mastoid portions of the facial nerve is discussed, and facial nerve anomalies, dehiscences and variations are described. Helpful landmarks for locating the facial nerve in the diseased and congenitally abnormal temporal bone are reviewed. A discussion of the etiology of immediate and delayed postoperative facial paralysis is presented, together with four illustrative case histories. Management of the problem is based upon accurate documentation of immediate versus delayed paralysis, and may vary from a period of watchful waiting to medical or surgical therapy. The modern otologic surgeon must be thoroughly familiar with the anatomy of the facial nerve within both the normal and the abnormal temporal bone. This familiarity is based upon the quality of his training, the scope of his surgical experience, continuing medical education, and upon an honest appraisal of his own capabilities. The current medicolegal climate dictates that it is better to refer a problem case than to suffer a bad result. This is likely to be the situation in the forseeable future.