Left Peripheral Nerve Palsy after Left Anterior Temporal Lobectomy for Mesial Temporal Sclerosis

We report a rare case of delayed peripheral facial paralysis following left anterior temporal lobectomy (ATL) for mesial temporal sclerosis in a 58-year-old woman with a long-standing history of seizures. Preoperative evaluation confirmed left temporal sclerosis as the epileptogenic focus. Surgery with neurophysiologic monitoring was performed, and initial postoperative assessment revealed no facial deficits. However, 4 days later, the patient developed left-sided peripheral facial paralysis (House-Brackmann grade 4), which improved after a 10-day course of oral corticosteroids. This case underscores that delayed facial paralysis, although uncommon, can occur after ATL, potentially due to mechanical or thermal injury near the geniculate ganglion or viral reactivation induced by direct manipulation or surgical stress. Awareness and timely follow-up are essential for early detection and management of such complications.