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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 52-56

Delayed facial nerve paralysis following tympanomastoid surgery


Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University, Bhubaneswar, Odisha, India

Date of Submission11-May-2021
Date of Acceptance28-Aug-2021
Date of Web Publication09-Dec-2021

Correspondence Address:
Dr. Santosh Kumar Swain
Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinga Nagar, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aiao.aiao_10_21

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  Abstract 


Facial nerve paralysis is the most severe form of cranial neuropathy that causes facial deformity. Late-onset or delayed facial nerve palsy is uncommon following tympanomastoid surgery, although it can occur up to 2 weeks following the procedure. Although pinpointing the specific reason for delayed facial nerve paralysis following tympanomastoid surgery is complex, several variables such as facial nerve injury and/or viral reactivation can play a role. Late facial nerve paralysis after tympanomastoid surgery is caused by exposure of the facial nerve and fallopian canal dehiscence. Late facial nerve paralysis may be produced by viral reactivation and damage to the chorda tympani nerve. This study aims to look at the prevalence, etiology, clinical signs, diagnosis, and current treatment options for delayed facial nerve paralysis following tympanomastoid surgery. The exact cause of delayed facial nerve paralysis after tympanomastoid surgery has significant consequences for therapy and prognosis. The use of steroid and antiviral drugs is helpful for the treatment of the delayed facial nerve paralysis due to viral reactivation. The overall prognosis of the delayed facial nerve paralysis following tympanomastoid operation is good. This article discusses the prevalence, etiopathogenesis, clinical features, diagnosis, and present treatment of late/delayed facial nerve palsy following the tympanomastoid operation.

Keywords: Delayed facial nerve paralysis, fallopian canal, tympanomastoid surgery, viral reactivation


How to cite this article:
Swain SK. Delayed facial nerve paralysis following tympanomastoid surgery. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2021;5:52-6

How to cite this URL:
Swain SK. Delayed facial nerve paralysis following tympanomastoid surgery. Ann Indian Acad Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2022 Jan 21];5:52-6. Available from: https://www.aiaohns.in/text.asp?2021/5/2/52/332060




  Introduction Top


The most visible cranial neuropathic disease is facial nerve paralysis. It results in obvious facial deformity and impacts the emotional aspect of a person, leading to social isolation and decreased self-esteem.[1] Tympanomastoid surgery is a routine surgical procedure performed commonly by otolaryngologists or otologists. In clinical practice, late facial nerve paralysis following tympanomastoid surgery is unusual. The connection between tympanomastoid operation and the development of facial nerve paralysis suggests that the surgery is to blame, casting doubt on the surgeon's technique. Facial nerve paralysis after tympanomastoid surgery is one of the greatest fears among otolaryngologist. It can occur after 3 days to 2 weeks after the surgery.[2] Many etiological factors postulated in the pathogenesis of the late-onset facial nerve paralysis. Although technological advancements such as the operating microscope, motorized surgical drill, and preoperative imaging of the temporal bone, the risk is still there for facial nerve paralysis. Iatrogenic trauma, medical history of the patient, patient examination, and imaging are all factors that affect the diagnosis, treatment, and prognosis of delayed facial nerve paralysis after tympanomastoid surgery.[2] The prediction of the late facial nerve paralysis following tympanomastoid surgery appears to be good. The delayed facial nerve paralysis after tympanomastoid surgery is infrequently reported in the medical literature. This review article aims to discuss the details of epidemiology, etiopathology, clinical presentations, diagnosis, treatment, and prognosis of delayed facial nerve paralysis following tympanomastoid surgery.


  Methods of Literature Search Top


Multiple systematic methods were used to find current research publications on delayed facial nerve paralysis after tympanomastoid surgery. We started by searching the Scopus, PubMed, Medline, and Google Scholar databases online. This search strategy recognized the abstracts of published publications, while other papers were discovered manually from the citations.

A search strategy using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was developed [Figure 1]. Randomized controlled studies, observational studies, comparative studies, case series, and case reports were evaluated for eligibility. This paper focuses only on the delayed facial nerve paralysis following tympanomastoid surgery. The search articles with immediate traumatic causes or any other causes other than delayed facial nerve paralysis following tympanomastoid surgery with their management are excluded. Review articles with no primary research data were also excluded.
Figure 1: Methods for literature search

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This paper examines the epidemiology, etiopathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of delayed facial nerve paralysis following tympanomastoid surgical procedure. This analysis provides a foundation for future prospective trials in late facial nerve palsy after tympanomastoid surgery. It will also serve as a catalyst for additional study into delayed facial nerve paralysis following tympanomastoid operation, allowing early detection and treatment.


  Epidemiology Top


Incidence of iatrogenic facial nerve palsy following tympanomastoid operation has been documented to be between 0.6% and 3.7%.[3] In the case of revision tympanomastoid surgery, the frequency of facial nerve paralysis is high as 4% to 10%.[4] Delayed facial nerve paralysis has been documented as a complication of different tympanomastoid and neurotologic surgeries.[5] The incidence of the delayed facial nerve paralysis following tympanomastoid surgery depends on the specific type of surgical procedure. Still, it is has been associated with surgery affecting because of manipulation of the facial nerve. The incidence of the delayed facial nerve paralysis following tympanomastoid surgery was documented as 1.4%.[6] In otologic surgery like stapedectomy, there is less chance of manipulating the facial nerve and the incidence of delayed facial nerve paralysis is <1%.[7] After cochlear implant surgery, 1.7% of people get delayed facial nerve paralysis.[8] The acoustic neuroma is operated by different approaches including transmastoid route. The chance of delayed facial palsy following surgery for acoustic neuroma varies between 2.2% and 30%.[9]


  Etiopathology Top


The cause of delayed onset facial nerve palsy following tympanomastoid surgery is uncertain. Facial nerve injury, neural devascularization, and viral reactivation have all been associated with delayed facial nerve palsy after tympanomastoid surgery.[6] A consequence of tympanomastoid surgery is facial nerve palsy. Following tympanomastoid operation, facial nerve paralysis can occur immediately or take several days. Ipsilateral facial nerve paralysis is often immediate and found after surgery and is usually caused by direct trauma to the facial nerve at the time of the surgery. Near facial nerve, paralysis may also occur due to the local anesthesia effect and regress thoroughly after few hours of the surgery.[10] Several reasons have been linked to the pathophysiology of delayed facial nerve paralysis after tympanomastoid surgery, including surgical trauma-induced neural edema, local anesthetic medication, and virus reactivation. During tympanomastoid surgery, the facial nerve is the most susceptible component in the middle ear. Accidental injury to the facial nerve during tympanomastoid surgery might result in facial nerve paralysis if the surgeon ignores the facial nerve's location.[11] This injury usually occurs when the bony defects of the fallopian canal often expected to be present. One study found that approximately 57% of the people have dehiscence of the fallopian canal at the oval window niche.[12]

The degree of facial nerve manipulation during tympanomastoid surgery is directly proportional to delayed facial nerve paralysis. This shows that facial nerve injuries, whether direct or indirect, might generate inflammation and edema inside the fallopian canal, resulting in face nerve palsy. By 24–48 h after manipulative stress to the facial nerve, inflammation and edema had reached their climax. The development of facial nerve paralysis, on the other hand, might take up to 11 days after tympanomastoid surgery.[13] Some other factors must be associated with explaining the significant delay between the surgical procedure and the onset of the facial nerve dysfunction. Reactivation of the latent virus following tympanomastoid surgery is not uncommon for causing delayed facial nerve paralysis. Cushing was the first to observe the latent herpes simplex virus (HSV) reactivating during a trigeminal nerve surgery in 1905.[14] After surgical intervention on the trigeminal nerve, herpes labialis lesions and other mucocutaneous or cutaneous lesions are often found along with the distribution of the nerve. The degree of neural manipulation during surgical procedures/tympanomastoid surgery is strongly related to the rate of postoperative HSV reactivation. Physical manipulation of the facial nerve or ganglion, which is generally dormant, might be one explanation for viral reactivation. Another plausible cause is impaired immune system function, which is a more significant stressor following tympanomastoid surgery. One study reported that magnetic resonance imaging (MRI) findings in delayed facial nerve paralysis patients following stapedectomy are similar to Bell's palsy.[15] This gives evidence that viral infection could be the cause of delayed facial nerve paralysis.[16] The revival of facial nerve paralysis might be linked to thermal damage. When nearing the entrance of the facial recess, thermal or vibration injury to the facial nerve can be a triggering factor for delayed facial nerve paralysis although it usually results in immediate postoperative facial nerve paralysis. In addition, patients with abnormal temporal bone such as hypoplasia of the aditus, mastoid antrum, and facial recess put the patient at risk of the delayed facial nerve paralysis following tympanomastoid surgery. The uncommon anatomic abnormalities of the temporal bone are frequently accompanied by a fallopian canal abnormality, lowering or even eliminating the Trautman's triangle and putting the patient at risk for delayed facial nerve paralysis. Slight injuries to the chorda tympani nerve, for example, stretching or retrograde facial nerve edema, may be responsible for late facial nerve paralysis after stapedectomy surgery.[17] To avoid late facial nerve paralysis, otorhinolaryngologists should avoid amputation or overstretching of the chorda tympanic nerve during surgery if at all feasible. The chorda tympani nerve can be lacerated, transected, or crushed during a traumatic injury, resulting in intraneural hemorrhage or edema. The prognosis and treatment options differ depending on the cause of the damage.[18] However, the traumatic injury of the chorda tympanic nerve leading to delayed facial nerve paralysis is controversial. There is a close relationship between diabetic angiopathy and neuropathy with facial nerve paralysis. Neurogenic factors play an important role for regulation of the microcirculation. In the case of diabetic neuropathy, there is damage to the facial nerve because of disturbances in hemodynamic with increased arteriovenous shunting and abnormal responses to the tissue injuries. Abnormal neurogenic regulations of the microvascular hemodynamics can result in microangiopathy which affects the facial nerve by the pathogenesis of ischemia.[19] So, identification of the exact cause is usually a challenge for management and outcome of the delayed facial nerve paralysis after tympanomastoid surgery.


  Clinical Manifestations Top


Facial nerve's function is crucial in a person's physical, psychological, and emotional composition. All of these components can be affected by facial nerve paralysis, resulting in social and vocational limitations. The condition of facial nerve paralysis causes significant alterations in facial function and appearance. The onset of the delayed facial nerve paralysis following tympanomastoid surgery is bimodal with two peaks: Early and late-onset.[20] The early formation of the facial nerve paralysis occurs around 3–5 days following tympanomastoid surgery due to neural edema, particularly in the meatal foramen.[20] It was thought that heat production and/or inflammation by drilling the temporal bone at the time mastoid surgery might indirectly result in intratubal facial nerve edema.[21] The facial nerve and/or chorda tympani nerves responsible for late-onset delayed facial nerve palsy after tympanomastoid operation may reactivate the herpes virus after tympanomastoid surgery.[22] Delayed facial nerve paralysis is most common on the same side of the operated ear. The delayed facial nerve paralysis is although reversible often results in dissatisfaction for the patient and also a surgeon. Patients who have their facial nerves paralyzed following ear surgery experience a considerable deal of psychological distress. Determination of onset of the delayed facial nerve paralysis, severity, duration, and recovery must be assessed for the patient. House-Brackmann (HB) grading system is often employed for assessment of the facial nerve.[23] One study showed delayed facial nerve paralysis after mastoid surgery for acoustic neuroma; patient developed Ramsay Hunt syndrome, where patients developed clinical features like rashes in the pinna and external auditory canal along with aural pain and vertigo with serological confirmation of the varicella-zoster infection.[24] Patients who experience delayed facial nerve paralysis after tympanomastoid surgery frequently experience psychosocial issues such as social disengagement, anxiety, negative body image, and low mood.


  Diagnosis Top


Serological investigations are done for the varicella-zoster virus. Because of viral reactivation, we may observe elevated immunoglobulin M (IgM) and IgG titers, resulting in late-onset facial nerve palsy following tympanomastoid surgery The geniculate ganglion region of the ear's exudate sent for the polymerase chain reaction (PCR) method and valuable for detecting varicella-zoster infection. In one study, researchers employed the PCR methodology to identify HSV type 1 (HSV-1) in the saliva of patients with late facial nerve paralysis following tympanomastoid surgery, finding that four out of five patients had raised titer HSV-1.[25] A high-resolution computed tomography (CT) scan often reveals the dehiscence of the fallopian canal. On the other hand, minor bone deformities may go undiagnosed due to the facial nerve's multiplanar and convoluted course. Obtaining an excellent picture of the fallopian canal necessitates the use of many planes of view.[26] One study showed that CT scan coincided with surgical findings in approximately 75% of the patients with around 66% sensitivity and about 84% specificity.[27] The facial nerve's complicated path necessitates a thorough radiological examination. The accuracy of MRI in identifying soft tissue lesions along the facial nerve, particularly in the neurological system, is higher. Gadolinium-enhanced MRI increases T1-weighted signal intensity. In the event of facial nerve paralysis caused by inflammation, increased capillary permeability to gadolinium is likely to cause a breakdown of the blood-peripheral nerve barrier. MRI often demonstrates abnormal enhancement of the facial nerve in delayed facial nerve palsy due to unknown causes.[28] From the brainstem's nucleus to the extratemporal route, MRI may examine the facial nerve at all levels. The edema in the fallopian canal is easily demonstrated by contrast-enhanced MRI. However, the time interval between the MRI scan and the diagnosis varies with the time period from diagnosis to the time of surgery, these differences may affect the alterations in the lesions.[28] CT scan is helpful to find out the injury of the fallopian canal or any bony compressive mass.


  Treatment Top


Although many reports suggest that full recovery can occur without minimal medication, with the development of facial nerve paralysis, therapy possibilities include steroids and antivirals. The delayed facial nerve paralysis caused by viral reactivation can be treated with steroid and antiviral medications. Prednisone and acyclovir, given within 3 days after the beginning of facial nerve paralysis, were shown to be effective in treating delayed facial nerve paralysis induced by viral reactivation in one trial. It was a successful treatment choice that resulted in the complete normalcy of facial nerve function.[29],[30] The use of the combination of corticosteroids and antivirals is an established treatment option in idiopathic facial nerve paralysis. When patients are put on acyclovir and prednisone within 3 days after the onset of facial nerve dysfunction, they have a good result.[6] Treatment of delayed facial nerve palsy after tympanomastoid surgery with acyclovir and prednisone is highly effective. However, the clinician should keep in mind regarding adverse effects of steroids. Steroids have several side effects including gastritis, increase blood glucose, osteoporosis, osteonecoris, hypertension, cataract, and myopathy.[31] Alternatively, prophylactic antiviral treatment can be started for preventing the delayed facial nerve paralysis. There is no doubt regarding HSV-I is often present as the latent state in the geniculate ganglion of the facial nerve and the surgical stress can reactivate this virus and result in facial nerve palsy.[32] Physical therapy, mainly neuromuscular retraining, is a valuable intervention for treating facial nerve paralysis. Fallopian canal decompression, particularly labyrinthine segment, is usually suggested to prevent delayed facial nerve paralysis in vestibular surgeries.[33] Routine facial nerve monitoring during tympanomastoid surgery is highly effective and essential to avoid face nerve damage.[34] Despite advancements in the operating microscope, microdrill, and preoperative imaging availability now minimize the chance of facial nerve paralysis following tympanomastoid operation.


  Prognosis Top


Routine facial nerve monitoring during tympanomastoid surgery is highly effective and essential to avoid face nerve damage. Most people with delayed facial nerve palsy only have a partial impairment, and many recover completely.[35] Although delayed facial nerve paralysis is usually reversible, it may result in dissatisfaction and worries among the patients and surgeons. In general, the patient's prognosis for delayed facial nerve paralysis is outstanding, with approximately 88% of cases returning to or exceeding the initial grading.[36] HB grade is used to assess the facial nerve outcome for delayed facial nerve palsy following tympanomastoid surgery. One study showed 100% of patients with HB Grade-II recovered completely at 1 year follow-up, although only 57% of the patients with delayed facial nerve palsy in HB Grade-III palsy at 1 year follow-up.[36] The data for cases those with delayed facial nerve palsy of HB Grade-I after surgery are more optimistic; 100% and 86% for delayed facial nerve palsy magnitudes of HB Grade-II and III respectively.[37]


  Conclusion Top


After tympanomastoid surgery, delayed paralysis of the facial nerve is an uncommon clinical occurrence. In otological practice and medical literature, this clinical occurrence is relatively unknown. As it had a favorable recovery rate, patients should be reassured, and corrective surgical procedures to restore facial nerve function should not be recommended. It is still unknown what causes delayed facial nerve paralysis following tympanomastoid surgery. After tympanomastoid surgery, viral reactivation and neural edema are still crucial factors in delayed onset facial nerve paralysis. More research is needed to confirm the mechanism of facial nerve damage. Because of the excellent recovery rate, the patient should be reassured and the patient should not undergo any surgical procedures for improving the facial nerve function.

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Conflicts of interest

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  References Top

1.
Hotton M, Huggons E, Hamlet C, Shore D, Johnson D, Norris JH, et al. The psychosocial impact of facial palsy: A systematic review. Br J Health Psychol 2020;25:695-727.  Back to cited text no. 1
    
2.
Swain SK, Das A, Mohanty JN. Acute otitis media with facial nerve palsy: Our experiences at a tertiary care teaching hospital of eastern India. J Acute Dis 2019;8:204-7.  Back to cited text no. 2
  [Full text]  
3.
Schuring AG. Iatrogenic facial nerve injury. Am J Otol 1988;9:432-3.  Back to cited text no. 3
    
4.
Wiet RJ. Iatrogenic facial paralysis. Otolaryngol Clin North Am 1982;15:773-80.  Back to cited text no. 4
    
5.
Vrabec JT. Delayed facial palsy after tympanomastoid surgery. Am J Otol 1999;20:26-30.  Back to cited text no. 5
    
6.
Safdar A, Gendy S, Hilal A, Walshe P, Burns H. Delayed facial nerve palsy following tympano-mastoid surgery: Incidence, aetiology and prognosis. J Laryngol Otol 2006;120:745-8.  Back to cited text no. 6
    
7.
Eckermann J, Meyer JE, Guenzel T. Etiology and therapy of delayed facial paralysis after middle ear surgery. Eur Arch Otorhinolaryngol 2020;277:965-74.  Back to cited text no. 7
    
8.
Fayad JN, Wanna GB, Micheletto JN, Parisier SC. Facial nerve paralysis following cochlear implant surgery. Laryngoscope 2003;113:1344-6.  Back to cited text no. 8
    
9.
Franco-Vidal V, Nguyen DQ, Guerin J, Darrouzet V. Delayed facial paralysis after vestibular schwannoma surgery: Role of herpes viruses reactivation--our experience in eight cases. Otol Neurotol 2004;25:805-10.  Back to cited text no. 9
    
10.
Wamkpah NS, Jeanpierre L, Lieu JE, Del Toro D, Simon LE, Chi JJ. Physical therapy for iatrogenic facial paralysis: A systematic review. JAMA Otolaryngol Head Neck Surg 2020;146:1065-72.  Back to cited text no. 10
    
11.
Swain SK, Das A, Munjal S. A rare cause of bilateral facial nerve paralysis due to acute otitis media in a 52-year-old man. Med J Dr. DY Patil Vidyapeeth 2020;13:688-91.  Back to cited text no. 11
    
12.
Sharma S, Srivastava A, Rahman A, Sinha ON, Mohan C. Intraoperative fallopian canal dehiscence in chronic otitis media. Int J Health Clin Res 2020;3:79-84.  Back to cited text no. 12
    
13.
Shea JJ Jr., Ge X. Delayed facial palsy after stapedectomy. Otol Neurotol 2001;22:465-70.  Back to cited text no. 13
    
14.
Cushing H. The surgical aspects of major neuralgia of the trigeminal nerve. A report of twenty cases of operation on the gasserian ganglion with anatomic and physiologic notes on the consequences of its removal. JAMA 1905;44:1002-8.  Back to cited text no. 14
    
15.
Eskander A, Holler T, Papsin BC. Delayed facial nerve paresis after using the KTP laser in the treatment of cholesteatoma despite inter-operative facial nerve monitoring. Int J Pediatr Otorhinolaryngol 2010;74:823-4.  Back to cited text no. 15
    
16.
Swain SK, Behera IC, Sahu MC. Bell's palsy among infants-our experiences in a tertiary care hospital of eastern India. Asian J Pharm Clin Res 2017;10:85-7.  Back to cited text no. 16
    
17.
Bae SH, Kwak SH, Nam GS, Jung J. Meta-analysis of delayed facial palsy following middle ear surgery. Otol Neurotol 2019;40:1109-15.  Back to cited text no. 17
    
18.
Swain SK, Behera IC, Sahu MC. Head injury with sudden onset bilateral facial palsy–Can happen without temporal bone fractures and brain injury!. Egypt J Ear Nose Throat Allied Sci 2016;17:23-5.  Back to cited text no. 18
    
19.
Callaghan BC, Gallagher G, Fridman V, Feldman EL. Diabetic neuropathy: What does the future hold? Diabetologia 2020;63:891-7.  Back to cited text no. 19
    
20.
Vrabec JT, Coker NJ, Jenkins HA. Delayed-onset facial paralysis after vestibular neurectomy. Laryngoscope 2003;113:1128-31.  Back to cited text no. 20
    
21.
Gianoli GJ, Kartush JM. Delayed facial palsy after acoustic neuroma resection: The role of viral reactivation. Am J Otol 1996;17:625-9.  Back to cited text no. 21
    
22.
Hengstman GJ, Gons RA, Menovsky T, Lunel FV, van de Vlasakker CJ, de Vries J. Delayed cranial neuropathy after neurosurgery caused by herpes simplex virus reactivation: Report of three cases. Surg Neurol 2005;64:67-9.  Back to cited text no. 22
    
23.
House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-7.  Back to cited text no. 23
    
24.
Kanerva M, Jones S, Pitkaranta A. Ramsay hunt syndrome: Long-term facial palsy outcome assessed face-to-face by three different grading scales and compared to patient self-assessment. Eur Arch Otorhinolaryngol 2021;278:1781-7.  Back to cited text no. 24
    
25.
Bonkowsky V, Kochanowski B, Strutz J, Pere P, Hosemann W, Arnold W. Delayed facial palsy following uneventful middle ear surgery: A herpes simplex virus type 1 reactivation? Ann Otol Rhinol Laryngol 1998;107:901-5.  Back to cited text no. 25
    
26.
Chakeres DW, Kapila A. Normal and pathologic radiographic anatomy of the motor innervation of the face. AJNR Am J Neuroradiol 1984;5:591-7.  Back to cited text no. 26
    
27.
Fuse T, Tada Y, Aoyagi M, Sugai Y. CT detection of facial canal dehiscence and semicircular canal fistula: Comparison with surgical findings. J Comput Assist Tomogr 1996;20:221-4.  Back to cited text no. 27
    
28.
Burgio DL, Siddique S, Haupert M, Meleca RJ. Magnetic resonance imaging of the facial nerve in children with idiopathic facial paralysis. Otolaryngol Head Neck Surg 2000;122:556-9.  Back to cited text no. 28
    
29.
Murakami S, Hato N, Horiuchi J, Honda N, Gyo K, Yanagihara N. Treatment of Ramsay Hunt syndrome with acyclovir-prednisone: Significance of early diagnosis and treatment. Ann Neurol 1997;41:353-7.  Back to cited text no. 29
    
30.
Swain SK, Choudhury J, Acharya S. Herpes zoster oticus among pediatric patients: Our experiences at a tertiary care teaching hospital. Indian J Health Sci Biomed Res (KLEU) 2020;13:215-20.  Back to cited text no. 30
    
31.
Bleecker ER, Menzies-Gow AN, Price DB, Bourdin A, Sweet S, Martin AL, et al. Systematic literature review of systemic corticosteroid use for asthma management. Am J Respir Crit Care Med 2020;201:276-93.  Back to cited text no. 31
    
32.
Li KH, Chan LP, Chen CK, Kuo SH, Wang LF, Chang NC, et al. Comparative study of endoscopic and microscopic type I tympanoplasty in terms of delayed facial palsy. Otolaryngol Head Neck Surg 2021;164:645-51.  Back to cited text no. 32
    
33.
Sargent EW, Kartush JM, Graham MD. Meatal facial nerve decompression in acoustic neuroma resection. Am J Otol 1995;16:457-64.  Back to cited text no. 33
    
34.
Choung YH, Park K, Cho MJ, Choung PH, Shin YR, Kahng H. Systematic facial nerve monitoring in middle ear and mastoid surgeries: “Surgical dehiscence” and “electrical dehiscence”. Otolaryngol Head Neck Surg 2006;135:872-6.  Back to cited text no. 34
    
35.
Gianoli GJ. Viral titers and delayed facial palsy after acoustic neuroma surgery. Otolaryngol Head Neck Surg 2002;127:427-31.  Back to cited text no. 35
    
36.
Arriaga MA, Luxford WM, Atkins JS Jr., Kwartler JA. Predicting long-term facial nerve outcome after acoustic neuroma surgery. Otolaryngol Head Neck Surg 1993;108:220-4.  Back to cited text no. 36
    
37.
Grant GA, Rostomily RR, Kim DK, Mayberg MR, Farrell D, Avellino A, et al. Delayed facial palsy after resection of vestibular schwannoma. J Neurosurg 2002;97:93-6.  Back to cited text no. 37
    


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