A patient has complete House-Brackmann grade VI facial palsy on the fifth postoperative day after uneventful acoustic neuroma excision; facial function was documented as normal immediately after surgery. Compared with a patient who awakens from surgery with an immediate complete palsy, this delayed palsy:
- A Has a better prognosis for spontaneous functional recovery ✓
- B Has a worse prognosis because it implies neural transection
- C Indicates injury at the cerebral peduncle rather than the nerve itself
- D Requires immediate re-exploration of the wound
Correct answer: A. Has a better prognosis for spontaneous functional recovery
Explanation
Delayed facial palsy appearing days to weeks after vestibular schwannoma surgery usually reflects oedema, vascular compromise or reactivation of latent viral infection rather than anatomical transection, and the majority recover well, often to House-Brackmann grade I or II. Immediate complete palsy more often signifies direct mechanical or thermal injury to the nerve and carries a poorer outlook. Management of the delayed type is conservative, so re-exploration is not indicated.
Reference: Cummings Otolaryngology Head and Neck Surgery, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.