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Delayed facial nerve paralysis post middle ear surgery: herpes simplex virus activation. Problem: Facial nerve paralysis following middle ear surgery is a nightmare for the otology surgeon. Usually this is caused by surgical trauma or local anaesthetic use. It is uncommon to see onset of facial nerve palsy more than 72 hours following the surgery.
Methodology: We report a case of facial nerve paralysis appearing 11 days following a successful canal wall-down mastoidectomy.
Results: Viral screening for Herpes Virus type 1 confirmed the viral aetiology of the delayed facial paralysis.
Conclusion: When an ipsilateral facial nerve palsy appears more than 72 hours after an uneventful middle ear procedure, without symptoms of any infection, suspect a viral reactivation.