High Altitude Alternobaric Facial Palsy: Case Series and Systematic Review of the Literature.

Abstract

Alternobaric facial palsy (AFP) is a rare phenomenon which occurs in patients with Eustachian tube dysfunction, a dehiscent facial canal, and subsequent compression induced ischemic neuropraxia of the facial nerve upon exposure to atmospheric pressure changes. There are few documented cases of AFP and most relate to underwater diving. There is limited understanding in the literature of AFP in the setting of high altitude, leading to a potential for misdiagnosis and inappropriate management. We present two cases of transient, recurrent, unilateral facial palsy at high altitude and perform a systematic review of the available literature. Full-text articles indexed to Medline, EMBase, and PubMed, and associated reference lists. Data was extracted into standardized data extraction forms. Binomial proportions and Fischer's exact test were used to analyze sex distribution and relationship between sex and side of palsy, and number of episodes experienced. Systematic review using PRISMA guidelines with meta-analysis. We identified 19 cases in the literature relating to AFP in patients at high altitude and present two new cases. AFP is an uncommon but important diagnosis. We present two cases and systematically review the literature to discuss the diagnosis and management of AFP.