To the Editor.—Facial palsy following tympanomastoid surgery has recently been reported1 due to local anesthetic effect. This has been attributed to the possible dehiscent facial canal in the middle ear. We have also seen patients with facial palsy following local anesthetic infiltration during middle ear surgery. We were, however, quite convinced of the integrity of the facial canal during surgery. The possible explanation is the effect of local anesthetic on the facial nerve at the level of the stylomastoid foramen. During parotid gland surgery, the facial nerve is identified as following the posterior belly of the digastric muscle and the external ear cartilage pointer. Hence, it is postulated that whenever local anesthetic is infiltrated near the mastoid tip for postaural or at the inferior osseocartilaginous junction for permeatal surgery, the local anesthetic seeps out to affect the facial nerve. Interestingly, in two patients there was a history of
RAMAN R, JOB A. Facial Palsy Following Local Anesthetic Infiltration for Middle Ear Surgery. Arch Otolaryngol Head Neck Surg. 1991;117(3):341. doi:10.1001/archotol.1991.01870150109021
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