FDP-GBS is an uncommon, localized form of Guillain-Barré syndrome, presenting with rapidly progressive bilateral facial weakness, distal paresthesia, and reduced reflexes without early limb weakness or ataxia. It accounts for less than 1% of all GBS cases. Postsurgical GBS is recognized but rare, usually developing within 1-3 weeks after surgery. 

A 43-year-old man with a history of diabetes underwent fracture repair surgery. Two weeks later, he developed distal paresthesia, tongue numbness, and progressive facial palsies. Examination showed symmetric facial diplegia, diminished deep tendon reflexes, preserved limb strength, and distal sensory loss. Brain MRI was unremarkable. CSF revealed albumin-cytologic dissociation with a normal IgG index. NCS/EMG revealed a demyelinating sensorimotor polyneuropathy with prolonged distal latencies and F-waves, sural sparing and bilaterally absent blink reflexes. He received IVIG for 3 days. Sensation improved, while facial diplegia persisted at discharge. 

This case demonstrates FDP-GBS that presented 2 weeks after orthopedic surgery. Post-surgical GBS, including this variant, tends to have a more severe and rapidly progressive course compared to non-surgical GBS, with a higher risk of respiratory involvement and poorer prognosis if not promptly recognized and treated. Orthopedic surgery is among the most common surgical triggers for GBS, and the onset of symptoms typically occurs within 1–3 weeks postoperatively. Anti-ganglioside antibodies are generally absent, distinguishing from others such as Miller Fisher syndrome. Most patients recover well, though paresthesias may persist longer than facial weakness.

GBS should be considered in patients presenting with bilateral facial palsy and distal paresthesia after recent surgery, even in the absence of preceding infection. FDP-GBS possibly after orthopedic surgery has not been previously reported. Early recognition and immunotherapy are important for timely management and recovery.