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May 2018

Postoperative Facial Baroparesis While Flying: A Rare Complication of Decompressing a Facial Nerve Schwannoma

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, The University of Iowa Carver College of Medicine, The University of Iowa Hospitals and Clinics, Iowa City
  • 2Division of Otolaryngology, Department of Surgery, The University of Wisconsin School of Medicine and Public Health, The University of Wisconsin-Madison, Madison
JAMA Otolaryngol Head Neck Surg. 2018;144(5):457-459. doi:10.1001/jamaoto.2018.0048

Facial baroparesis is a rare phenomenon thought to arise from middle ear pressure-induced ischemic neurapraxia while flying or scuba diving. Most cases occur spontaneously in healthy individuals, some of whom have symptoms suggestive of eustachian tube dysfunction. A few have evidence of dehiscent fallopian canals likely developmental in origin. We describe a unique iatrogenic mechanism of baroparesis in a patient who underwent surgical treatment of a facial nerve (FN) schwannoma. Two years later, the patient developed postoperative reversible facial weakness during flight ascent with resolution on descent. To our knowledge, this particular postoperative complication has not previously been reported after FN decompression. The patient underwent revision decompression resulting in resolution of altitude-triggered facial paresis. Facial nerve decompression carries the unlikely risk of baroparesis, warranting attention so as to improve preoperative patient counseling and intraoperative consideration of more extensive facial nerve decompression.

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