Óvári Attila, Bielenberg Max, Neuner Bruno, Meyer Jens Eduard
Department of Oto-Rhino-Laryngology, Bodden-Kliniken, Sandhufe 2, 18311, Ribnitz-Damgarten, Germany.
Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Plastic Surgery, Asklepios Klinik St. Georg, Hamburg, Germany.
Eur Arch Otorhinolaryngol. 2025 Apr 12. doi: 10.1007/s00405-025-09384-y.
To identify probable triggers of delayed facial palsy (DFP) after middle ear surgery.
Retrospective single-center chart review of DFP cases between 2010 and 2021.
Forty patients with DFP could be identified after 3,508 middle ear surgeries (1.14%). The occurrence of DFP was after tympanoplasty type 1 1.60%, after tympanoplasty type 3 without mastoidectomy 1.32%, after tympanoplasty type 3 with mastoidectomy 0.36%, and after all tympanomastoid surgery cases 0.35%. The anti-HSV-1 IgM was positive in three cases and borderline in two patients. The anti-VZV IgM was positive in three cases. Beside herpes virus reactivation, facial canal dehiscence (n = 8), bacterial infection, direct nerve microtrauma and intratympanal use of collagenous or oxidized cellulose sponges are presumed pathogenetic factors in our study.
The etiology of DFP is still not conclusively clarified, it has probably a heterogeneous pathogenesis and therefore requires further scientific research. Mastoidectomy may have a protecting effect against DFP. The risk may be reduced by avoiding possible promoting factors but this adverse event cannot be substantially eliminated yet. Nonetheless, we summarize practical considerations for the prevention, diagnosis, and therapy of DFP in the future.
确定中耳手术后迟发性面瘫（DFP）的可能触发因素。
对2010年至2021年间的DFP病例进行回顾性单中心病历审查。
在3508例中耳手术后可确定40例DFP患者（1.14%）。DFP的发生率在1型鼓室成形术后为1.60%，在3型鼓室成形术无乳突切除术后为1.32%，在3型鼓室成形术有乳突切除术后为0.36%，在所有鼓室乳突手术病例后为0.35%。3例抗HSV-1 IgM阳性，2例临界。3例抗VZV IgM阳性。除疱疹病毒再激活外，面神经管裂开（n = 8）、细菌感染、直接神经微创伤以及鼓室内使用胶原或氧化纤维素海绵在我们的研究中被认为是致病因素。
DFP的病因仍未得到最终明确，其发病机制可能具有异质性，因此需要进一步的科学研究。乳突切除术可能对DFP有保护作用。通过避免可能的促发因素可降低风险，但这种不良事件仍无法大幅消除。尽管如此，我们总结了未来DFP预防、诊断和治疗的实际考虑因素。
