Document Detail


Magnetic resonance imaging findings in delayed facial palsy after stapes surgery.
MedLine Citation:
PMID:  20657331     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: 1. To retrospectively review the pathophysiology and radiologic features of delayed facial palsy after stapedectomy. 2. To discuss the cause and management strategy of this unusual problem.
PATIENTS: Four hundred fifty stapedectomies performed between 2001 and 2007 by a single surgeon were retrospectively reviewed. Two patients in this series developed a delayed facial palsy postoperatively.
INTERVENTIONS: Magnetic resonance imaging (MRI) was performed on patients with delayed facial palsy after stapedectomy and was repeated as their clinical symptoms resolved. The patients were treated medically with oral corticosteroids and antiviral medications.
MAIN OUTCOME MEASURES: The clinical course and radiographic characteristics on MRI of patients with delayed facial palsy are presented.
RESULTS: Two of 450 patients who underwent stapedectomies (0.4%) during a 7-year period developed the rare complication of delayed facial palsy (postoperative Days 12 and 41, respectively). Both patients experienced periauricular pain and dysgeusia, followed by rapidly progressive complete facial nerve paralysis. The operated ear showed no sign of infection. MRI with gadolinium of the internal auditory canal demonstrated enhancement of the labyrinthine portion of the facial nerve as seen in Bell's palsy. Both patients were treated with oral corticosteroids and antiviral medications. Subsequent imaging revealed decreased enhancement with resolution of facial paralysis.
CONCLUSION: In the rare complication of delayed facial palsy after stapedectomy, MRI findings support the hypothesis that reactivation of a latent virus is the underlying cause. Therefore, delayed facial paralysis after stapedectomy should be treated similarly to Bell's palsy with steroid and antiviral medical therapy.
Authors:
Marc Cohen; Ashley Balaker; Claudia Kirsch; Abie Mendelsohn; Akira Ishiyama
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  31     ISSN:  1537-4505     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-25     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1153-6     Citation Subset:  IM    
Affiliation:
Division of Head and Neck Surgery, University of California-Los Angeles School of Medicine, Los Angeles, California, U.S.A.
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Anti-Inflammatory Agents / therapeutic use
Antiviral Agents / therapeutic use
Facial Paralysis / etiology*,  pathology*,  virology
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Pain, Postoperative / drug therapy,  epidemiology
Postoperative Complications / pathology*,  virology
Retrospective Studies
Stapes Surgery / adverse effects*
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Inflammatory Agents; 0/Antiviral Agents

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