Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (5): 1-5.doi: 10.6040/j.issn.1673-3770.0.2022.209

   

An analysis of the clinical characteristics of delayed facial paralysis following middle ear surgery

WEN Liting1,2, LI Xu3, GAO Wei4, HU Tianyong1, ZENG Xianhai1, ZHA Dingjun2   

  1. 1. Department of Otolaryngology, Longgang E.N.T hospital & Shenzhen Key laboratory of E.N.T, Institute of E.N.T, Shenzhen, 518172, Guangdong, China;
    2. Department of Otorhinlaryngology & Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an 710032, Shaanxi, China;
    3. Department of Otolaryngology, the 984 Hospital of the People's Liberation Army, Beijing 100094, China;
    4. Department of Otorhinlaryngology & Head and Neck Surgery, Tangdu Hospital, Air Force Medical University, Xi'an 710038, Shaanxi, China
  • Published:2022-09-20

PDF (PC)

277

Abstract: Objective To explore the causes, treatments, and outcomes of delayed facial paralysis(DFP)after different types of middle ear surgery. Methods A retrospective study was done on the clinical data of 1 124 cases experienced middle ear surgery from January 2017 to December 2018, including onset, risk factors, treatment and rehabilitation of DFP. Results Among the 1 124 patients who underwent middle ear surgery, 17(1.51%)presented DFP 3-20 days after surgery, with an average incidence at 10.00±4.11 days. The incidence of DFP after type Ⅰ tympanoplasty, type Ⅱ tympanoplasty, and tympanoplasty with mastoidectomy of the canal wall down were 2.30%, 1.62%, and 0.95%, respectively, and the differences were not statistically significant. The incidence of DFP in 776 patients with intact facial canal and 348 with dehiscent facial canal were 1.55% and 1.44%, respectively, and this difference also was not statistically significant. In addition, postoperative infection with Pseudomonas aeruginosa occurred in one of the patients with DFP who was later treated with a great auricular nerve graft and facial nerve anastomosis. The patient's condition improved to grade III a year after surgery. The remaining 16 patients were treated with steroids as conservative management, and their conditions were fully restored after 0.5-3 months. Conclusion The possible cause of DFP following middle ear surgery has nothing to do with surgical approaches and facial canal dehiscence. Notably, conservative management resulted in good outcomes.

Key words: Delayed facial paralysis, Middle ear, Tympanoplasty, Tympanoplasty with mastoidectomy of cannal wall down, Facial nerve, Anastomosis

CLC Number: 

  • R764.2
[1] 田雨鑫, 王菁菁, 王慧, 等. 医源性面瘫的手术治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 20-24. doi:10.6040/j.issn.1673-3770.1.2019.054. TIAN Yuxin, WANG Jingjing, WANG Hui, et al. Surgical treatment of iatrogenic facial paralysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 20-24. doi:10.6040/j.issn.1673-3770.1.2019.054.
[2] Eckermann J, Meyer JE, Guenzel T. Etiology and therapy of delayed facial paralysis after middle ear surgery[J]. Eur Arch Otorhinolaryngol. 2020,277(4): 965-974. doi: 10.1007/s00405-020-05825-y.
[3] 中华医学会耳鼻咽喉头颈外科学分会耳科学组,中华耳鼻咽喉头颈外科杂志编辑委员会耳科组. 中耳炎临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志, 2013(1): 5-5.doi: 10.3760/cma.j.issn.1673-0860.2013.01.003.
[4] Tolisano AM, Hunter JB, Sakai M, et al. Determining etiology of facial nerve paralysis with MRI: challenges in malignancy detection[J]. Ann Otol Rhinol Laryngol, 2019, 128(9): 862-868. doi:10.1177/0003489419848462.
[5] Thorne MC, Dunham BP, Tom LW. Delayed facial paresis following tympanomastoid surgery in a pediatric patient[J]. Ear Nose Throat J, 2010, 89(8): 357-361.
[6] 姜立伟, 潘滔. 鼓室成形术后迟发性面瘫临床特征[J]. 临床耳鼻咽喉头颈外科杂志, 2015, 29(22): 2003-2004. doi:10.13201/j.issn.1001-1781.2015.22.018.
[7] Eskander A, Holler T, Papsin BC. Delayed facial nerve paresis after using the KTP laser in the treatment of cholesteatoma despite inter-operative facial nerve monitoring[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(7): 823-824. doi:10.1016/j.ijporl.2010.03.052.
[8] Xu P, Liu W, Zuo W, et al. Delayed facial palsy after tympanomastoid surgery: a report of 15 cases[J]. Am J Otolaryngol, 2015, 36(6): 805-807. doi:10.1016/j.amjoto.2015.07.004.
[9] 李永奇, 陈愈彬, 尹根蒂, 等. 鼓室乳突术后迟发性周围性面神经麻痹的临床诊治[J]. 中华耳科学杂志, 2016, 14(5): 629-633. doi:10.3969/j.issn.1672-2922.2016.05.015. LI Yongqi, CHEN Yubin, YIN Gendi, et al. Diagnosis and treatment of patients with delayed peripheral facial nerve paralysis after tympano-mastoid surgeries[J]. Chinese Journal of Otology, 2016, 14(5): 629-633. doi:10.3969/j.issn.1672-2922.2016.05.015.
[10] Révész P, Piski Z, Burián A, et al. Delayed facial paralysis following uneventful KTP laser stapedotomy: two case reports and a review of the literature[J]. Case Rep Med, 2014: 971362. doi:10.1155/2014/971362.
[11] Mills R, Szymanski M, Abel E. Delayed facial palsy following laser stapedectomy: in vitro study of facial nerve temperature[J]. Clin Otolaryngol Allied Sci, 2003, 28(3): 211-214. doi:10.1046/j.1365-2273.2003.00691.x.
[12] De Stefano A, Neri G, Kulamarva G. Delayed facial nerve paralysis post middle ear surgery: herpes simplex virus activation[J]. B-ENT, 2009, 5(1): 47-50.
[13] Shea JJ, Ge X. Delayed facial palsy after stapedectomy[J]. Otol Neurotol, 2001, 22(4): 465-470. doi:10.1097/00129492-200107000-00009.
[14] Salvinelli F, Casale M, Vitaliana L, et al. Delayed peripheral facial palsy in the stapes surgery: can it be prevented? [J]. Am J Otolaryngol, 2004, 25(2): 105-108. doi:10.1016/j.amjoto.2003.11.010.
[15] Kitahara T, Kubo T, Doi K, et al. Delayed facial nerve palsy after otologic surgery[J]. Nihon Jibiinkoka Gakkai Kaiho, 2006, 109(7): 600-605. doi:10.3950/jibiinkoka.109.600.
[16] 于春刚, 李健东. 多组颅神经受累的不典型Hunt综合征一例报告[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 167-168. doi:10.6040/j.issn.1673-3770.0.2018.170. YU Chungang, LI Jiandong. A case of untypical Hunt syndrome involving multiple groups of cranial nerves[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 167-168. doi:10.6040/j.issn.1673-3770.0.2018.170.
[17] Sullivan FM, Swan IR, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy[J]. N Engl J Med, 2007, 357(16): 1598-1607. doi:10.1056/nejmoa072006.
[18] Bae SH, Kwak SH, Nam GS, et al. Meta-analysis of delayed facial palsy following middle ear surgery\J]. Otol Neurotol, 2019, 40(8): 1109-1115. doi:10.1097/mao.0000000000002318.
[1] ZHAO Xiaobing,ZHANG Dawei, CHEN Renjie. A case of middle-ear anaplastic large T- cell lymphoma and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 7-14.
[2] YANG Yang, WANG Xiaoxu, ZHANG Jie. Progress on diagnosis and treatment of middle ear cholesteatoma in children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 1-6.
[3] MA Ning, CHEN Min, LIU Wei, YANG Yang, SHAO Jianbo, HAO Jinsheng, LIU Bing, ZHANG Xiao, DUAN Xiaomin, ZHANG Qifeng, ZHANG Jie. Clinical characteristics and management of pediatric temporal bone fractures [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 13-19.
[4] DANG Panhong, ZHANG Rui, HU Chunyan, WANG Jie, FAN Mengyun. Clinical analysis of facial nerve decompression via an external transmastoid-subtemporal labyrinth approach in eight children [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 37-42.
[5] LI Ling, LI Cong, SUN Yan, CHEN Liang. A case of an infant with embryonal rhabdomyosarcoma in the middle ear and literature review [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(1): 55-59.
[6] WAN Yining, ZHANG Dejun, FU Zeming, GUO Fang, GUO Yingyuan, GUAN Guofang. Diffusion-weighted imaging for accurate diagnosis of congenital middle ear cholesteatoma and JOS staging [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 65-69.
[7] FAN HuijuanOverview,ZHANG HailiGuidance. Advancements of HIF-1α and VEGF in middle ear cholesteatoma [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(5): 93-97.
[8] Zhili WANG,Zhe CHEN,Fangyu LIN,Yongchuan CHAI,Zhaoyan WANG. Facial nerve reconstruction in the parotid area under a variety of circumstances [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 15-19.
[9] Yuxin TIAN,Jingjing WANG,Hui WANG,Yaqin WU,Haibo SHI,Zhengnong CHEN. Surgical treatment of iatrogenic facial paralysis [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 20-24.
[10] Zhao HAN, Juan DING. Physiology and pathology review of the middle ear muscles [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 6-10.
[11] NI Jing, LEI Fei, BAI Dan, ZHOU Yun, MA Jianmei, HUANG Wei, WANG Chunyang. Expression of immunological markers in middle ear effusion in children with secretory otitis media [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 56-59.
[12] Wei LIN,Dongchao ZHU,Zhibin CHEN. Short-term effects of artificial titanium auditory ossicles in stage I mastoidectomy and tympanoplasty [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 66-70.
[13] MENG Wei, YU Zhenkun, ZHENG Yali, LI Guangfei, LIANG Longjun, WANG Xiaomin. Simulation of the biomechanical effects of deaf appendage implantation in mastoid cortical bone [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 27-30.
[14] MENG Lixin, LI Jian, WEI Shanwen. Insertion of microtubules in tympanic membrane for the treatment of middle ear atelectasis [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 61-65.
[15] CHEN Tao, LIU Shanping, LU Yongtian. Analysis of tympanic sinus CT classification and surgical procedure in management of otitis media [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(4): 14-16.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Website Copyright: Editorial Office of Journal of Otolaryngology and Ophthalmology of Shandong University
Address: No.27 Shanda South Road, Jinan, Shandong, China. Post code: 250100 Tel: +86-0531-88366912 Email: ebhxb@sdu.edu.cn Supported by Beijing Magtech Co.Ltd