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Magnetic Resonance Imaging Findings in Delayed Facial Palsy After Stapes Surgery

Cohen, Marc*; Balaker, Ashley*; Kirsch, Claudia; Mendelsohn, Abie*; Ishiyama, Akira*

doi: 10.1097/MAO.0b013e3181eb3259
Facial Nerve
  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.

*Division of Head and Neck Surgery, University of California-Los Angeles School of Medicine, Los Angeles, California; and †Department of Radiology, Ohio State University, Columbus, Ohio, U.S.A.

Address correspondence and reprint requests to Ashley Balaker, M.D., 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095; E-mail:

© 2010 Otology & Neurotology, Inc.