DELAYED FACIAL PARALYSIS AFTER ACOUSTIC NEUROMA SURGERY - FACTORS INFLUENCING RECOVERY

Patients with satisfactory facial nerve function [House-Brackmann (HE) grade I or II] immediately after acoustic neuroma surgery are at risk for delayed facial paralysis. To study this problem, 255 consecutive patients who underwent acoustic neuroma excision with facial nerve pre servation were identified. Delayed facial paralysis occurred in 62 (24 .3%) patients; 90% ultimately recovered to their initial post operativ e HB grade, and 98.3% recovered to within one grade of their initial H B level. Paralysis occurred at an average of 3.65 postoperative days ( range, 1-16 days). The average time to maximal recovery for those with changes of 1, 2, 3, and 4 HB grades was 5.6, 21.5, 39.8, and 50.5 wee ks, respectively. The early onset of paralysis (<48 h after surgery) r esulted in shorter average recovery times. Of patients who demonstrate d nerve deterioration to grades IV-VI, 20 of 38 required tarsorrhaphy or gold-weight placement. We conclude that the overwhelming majority o f patients with delayed facial paralysis after acoustic neuroma surger y do eventually recover to their postoperative HE grade. The magnitude and timecourse of delayed facial paralysis are predictive factors for subsequent recovery.