This study aimed to review the incidence, outcomes and treatment of delayed facial nerve palsy (DFP) following otological surgery.

MEDLINE, Pubmed, Embase and The Cochrane Central Register of Controlled Trials were searched up to 10 May 2024. A systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of studies reporting on DFP following otological surgery. The risk of bias was assessed using the JBI critical appraisal tools.

Forty-nine articles were included with 201 instances of DFP following 24,917 operations from 1967 to 2021. The mean day of onset post-operatively was 8.4. 93 per cent of episodes fully recovered, with most cases taking between eight days and one month to recover.

Many theories of the pathogenesis of DFP exist. It is rare and has an excellent prognosis following treatment with corticosteroids with or without anti-viral therapy.

The current study evaluated the effectiveness of endoscopic transcanal facial nerve decompression in patients with post-traumatic facial nerve paralysis.

This retrospective study included 10 patients with post-traumatic complete facial nerve paralysis who underwent endoscopic transcanal facial nerve decompression. The surgical technique was explained step by step, and the surgical complications, hearing status and facial nerve function 12 months post-operatively were reported.

Endoscopic transcanal facial nerve decompression allowed exposure of the geniculate ganglion to the mastoid segment. The facial nerve function improved from House–Brackmann grade VI to grades I and II in 8 of 10 (80 per cent) patients, and 2 patients experienced partial recovery (House–Brackmann grades III and IV). No severe complication was reported.

Endoscopic transcanal facial nerve decompression, involving the nerve from the geniculate ganglion to the mastoid segment, is a safe and effective approach in patients with post-traumatic facial nerve paralysis.