Facial nerve sheath hematoma and paralysis after cochlear implant surgery

A 45-year-old man with a history of sudden bilateral hearing loss presented for cochlear implantation. The procedure was performed in the usual fashion and without any apparent intraoperative complications. Upon recovery in the postanesthesia unit, the patient had complete right facial paralysis (House-Brackmann score of VI/VI). The paralysis failed to improve with the administration of steroids, and after several hours the patient was returned to the operating room for exploration.