INTRODUCTION: Facial nerve palsy has been observed sporadically by aviation medicine doctors in recent years. We present two case reports of patients with the rare condition of facial nerve palsy occurring during aviation, along with a review of the literature, an overview of the phenomenon and the described symptoms of the cases. PubMed® including Medline® was searched using the terms nerve palsy and aviation with no restriction. In addition, two new cases of recurrent nerve palsy are described. CASE REPORTS: We describe two case reports: A 20-yr-old woman reported recurrent transient left-sided facial nerve palsy with increased duration and intensity on four subsequent flights, and a 35-yr-old woman who reported a left-sided transient facial nerve palsy 20 min after ascent. DISCUSSION: Included in the systematic review were 17 studies. Only case report studies were found. Including the two cases of facial nerve palsy described in this article, the reviewed studies represent 23 cases of peer-reviewed facial baro-palsy in aviation (ages 10 to 62 yr old). Having baro-palsy symptoms during flight is a rare condition, and the mechanism is not well understood. Some typical characteristics and possible mechanisms are discussed. PE tube insertion of the tympanic membrane has been found to be an effective treatment; however, further studies are needed.