Mastoidectomy and Endolymphatic Sac Decompression Procedure Causes Facial Nerve Injury

This case involves a 26-year-old female patient who underwent a mastoidectomy as part of an endolymphatic sac decompression operation. The procedure was met with several complications including major damage to the facial nerve and a syndrome known as Synkinesis. The nerve injury and synkinesis have caused numbness around her mouth, a drooping eyelid, facial twitching, and hyper lacrimation.

Question(s) For Expert Witness

1. Was this surgery necessary or could some other means of intervention have been employed to more aptly avoid the complications?

Expert Witness Response E-005001

The first consideration is whether the patient's diagnosis merited the surgery. ELS decompression is only performed for Meniere's disease, there are studies that demonstrate a 70-80% success rate in the treatment of this condition so it is appropriate to perform. Facial nerve injury should have been mentioned as a risk of surgery. Secondly, during the surgery facial nerve monitoring should have been used, if not this is a breach of typical standard practice. Once a facial nerve injury was identified (if it was known at the time), the nerve should have been decompressed above and below the site of injury (if the nerve is intact) and steroids administered. If not known at the time of surgery, the patient should have been taken back to OR for decompression once facial nerve paralysis was detected. If the nerve was transected it should have been re-approximated or a cable graft placement could have been done as an alternative.