Parálisis facial periférica después de amigdalectomía extracapsular

Abstract

Introduction and objective: Extracapsular tonsillectomy is one of the most frequent procedures in Otolaryngology. Complications usually do not occur except for those resulting from bleeding problems. We present two cases of facial paralysis in the immediate postoperative period and its possible causes. Material and Method: We perform adenotonsillectomy always under general anesthesia. We put the patients in Rose's position, and we use McIvor's mouth opener. The adenoidectomy was performed by curettage. Subsequently, bupivacaine + epinephrine 2.5 / 0.005 mg / ml was infiltrated in each anterior pillar. Total tonsillectomy was performed with bipolar forceps with minimal bleeding. Case 1: A 4-year-old girl weighing 11 kg with a history of growth retardation, diagnosed with moderate OSA, underwent a total adenotonsillectomy. The patient left the operating room in good condition. In the recovery room, grade IV peripheral facial paralysis of the House-Brackmann classification is observed. The facial paralysis was resolved in the following 12 hours; a descending pattern of prednisone 1 mg/kg daily was administered. Case 2: A 2-year-old girl weighing 17 kg with no relevant history, diagnosed with moderate OSA, underwent a total adenotonsillectomy. In the immediate postoperative period, when the patient was extubated, grade III left facial paralysis of the House-Brackmann classification was observed. Finally, the paralysis progressively improved in 6 hours, a dose of prednisone 1 mg/kg was administered. Results: The maximum dose of Bupivacaine in children is 2mg / kg. The presence of vasoconstrictor decreases the rate of absorption, which decreases systemic toxicity, prolongs the duration of action, increases the intensity of the blockade and decreases the surgical hemorrhage. In the literature we find few described cases of facial paralysis following tonsillectomy, which are related to the forced opening of the airway in case of difficult intubation or anesthetic infiltration and its diffusion. Because of the way of presentation and its rapid disappearance, we are inclined to think that our cases are of the second type. Conclusions: Peritonsillar infiltration of local anesthetic during tonsillectomy can provide a benefit by reducing bleeding and surgical time, as well as helping the control of postoperative pain. As it is a common procedure in Otolaryngology, we must know the surgical anatomy and sites of infiltration of local anesthetic and its adequate quantity for each patient. Peripheral facial paralysis is a rare complication, it can be transient and recover spontaneously without needing any treatment.