FACIAL-NERVE PALSY IN MASTOID SURGERY

The risk of facial nerve injury during mastoid surgery has decreased s ubstantially since the advent of the microscope and the otological dri ll. However, the facial nerve remains at risk during mastoid surgery w ith the present day incidence suggested to be one per cent. Despite th e severity of this complication there are no recent studies that accur ately quantify the incidence or discuss its management. The aims of th is study were to identify the risk of facial nerve injury for both the specialist as well as the trainee specialist and to review a manageme nt protocol for this complication. During the 10-year period from 1985 to 1994, 1024 consecutive mastoidectomies were reviewed. A total of 1 7 palsies was identified, seven were complete and 10 were incomplete. Of the seven complete palsies, four patients had decompression only an d recovered to House Brackmann Grade 2 or better while three patients had decompression and grafting, of these, two were available for follo w-up and recovered to House Brackmann Grade 4 only. All the partial pa lsies, barring one lost to follow-up, who were treated conservatively with pack removal, toilet and topical therapy recovered to House Brack mann Grade 2 or better. A management protocol followed for the above p atients is presented and the results analysed. Specific operations and manoeuvres which may put the facial nerve at risk intra-operatively a re also discussed.