Iatrogenic facial nerve palsy: lessons to learn

Introduction: This study aims to review the management and discuss the outcome of patients with iatrogenic facial nerve palsy. Methods: 11 patients with iatrogenic facial nerve palsy (FNP) were evaluated retrospectively in a tertiary centre between June 1995 and September 2008. All the cases were referred from other centres. Results: Ten patients had iatrogenic immediate FNP secondary to mastoidectomy and one had FNP secondary to superficial parotidectomy. Of the ten cases, three had concomitant profound sensorineural hearing loss and one had concomitant labyrinthine fistula. Ten patients underwent facial nerve exploration and one patient was managed conservatively. The second genu was the commonest site of injury ( 60 percent). Facial nerve recoveries were achieved to Grade I House Brackmann classification in five cases, Grade II in two cases and Grade III in two cases postoperatively. One case defaulted follow-up. One patient, managed conservatively, recovered to FNP Grade II after five months post-injury. Conclusion: Mistakes that most likely occurred during mastoid surgery are drilling towards the antrum, causing injury to the facial nerve at the second genu. Early facial nerve exploration and neurolysis resulted in good facial nerve recovery.