Delayed facial paralysis after stapedotomy using KTP laser

Objective: Delayed facial paralysis after stapes surgery is uncommon and ha s been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of del ayed facial nerve paralysis associated with the use of the potassium titany l phosphate (KTP) laser for stapedotomy Etiologic mechanisms are discussed. Study Design: The study was a descriptive study-case report. Setting: The study was conducted at a university-based otologic practice. Patients: Two patients with otosclerosis and delayed onset facial palsy 5 t o 7 days after uncomplicated stapedotomy using the KTP laser were included in the study. Intervention: Potassium titanyl phosphate laser stapedotomy was performed. Patients received treatment of facial palsy with a tapering course of oral steroids. Main Outcome Measure: House-Brackmann facial nerve grade scores were used. Results: Improvement of House-Brackmann facial nerve scores from Grade VI t o Grade I-II in one patient, and improvement from Grade TV to Grade I-II in the other was seen. Conclusion: The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by t hermal stress of the KTP laser. Presentation and resolution of the facial p alsy is similar to other types of delayed facial palsy resulting from nonla ser techniques of stapes surgery and other types of middle ear and neurotol ogic surgeries previously reported.