Delayed facial paralysis after stapedotomy using KTP laser.

OBJECTIVE

Delayed facial paralysis after stapes surgery is uncommon and has been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of delayed facial nerve paralysis associated with the use of the potassium titanyl phosphate (KTP) laser for stapedotomy. Etiologic mechanisms are discussed.

METHODS

The study was a descriptive study-case report.

METHODS

The study was conducted at a university-based otologic practice.

METHODS

Two patients with otosclerosis and delayed onset facial palsy 5 to 7 days after uncomplicated stapedotomy using the KTP laser were included in the study.

METHODS

Potassium titanyl phosphate laser stapedotomy was performed. Patients received treatment of facial palsy with a tapering course of oral steroids.

METHODS

House-Brackmann facial nerve grade scores were used.

RESULTS

Improvement of House-Brackmann facial nerve scores from Grade VI to Grade I-II in one patient, and improvement from Grade IV to Grade I-II in the other was seen.

CONCLUSIONS

The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by thermal stress of the KTP laser. Presentation and resolution of the facial palsy is similar to other types of delayed facial palsy resulting from nonlaser techniques of stapes surgery and other types of middle ear and neurotologic surgeries previously reported.