Case Report: Delayed Facial Nerve Paralysis—An Uncommon Complication of Tympanomastoid Surgery

Introduction Facial nerve paralysis after ear surgery is a troublesome postoperative complication for both patient and the surgeon. Delayed postoperative facial nerve paralysis (DPOFNP) occurs a few days after ear surgery. The cause for this condition is supposed to be reactivation of dormant herpes zoster virus present in geniculate ganglion.

Case Presentation We, hereby, present a case of 25-year-old male, a case of chronic suppurative otitis media atticoantral disease who underwent canal wall down mastoidectomy with tympanoplasty. He presented with complaints of facial nerve paralysis, 7 days after the surgery. Patient had a House–Brackmann grade-3 paralysis. Treatment was initiated with oral corticosteroids and oral acyclovir. Patient was recovered completely after the therapy.

Discussion DPOFNP is an uncommon complication following uneventful tympanomastoid surgery. It is due to mechanical reactivation of HSV-1 virus in geniculate ganglion following mechanical disturbance of chorda tympani or operating in close vicinity to the facial nerve. It can also occur following neuro-otological surgery like acoustic neuroma and vestibular neurectomy, following stapedectomy or cochlear implantation.

Conclusion Patient presenting with facial nerve paralysis a few days after uneventful tympanomastoid surgery should be diagnosed as DOPFNP. The patient should be reassured and given a course of oral corticosteroids and acyclovir. Overall prognosis is good.