Late decompression in patients with acute facial nerve paralysis after temporal bone fracture

Abstract

Objective: The aim of this paper was to address the management of acute facial nerve paralysis after temporal bone fracture and the outcomes of late decompression.

Methods: The study design was a retrospective review of eight patients who underwent late decompression of acute facial nerve paralysis due to temporal bone fracture involving the geniculate region. Pre-operative electrophysiological testing showed total degeneration of the facial nerve in all patients. The mean operation period was 70.1 +/- 54.8 days after the trauma. A pure middle fossa approach and combined approach included middle cranial fossa and transmastoid approaches and were used in six and two patients, respectively. Evaluation of the facial nerve function was graded according to the House-Brackmann grading scale.

Results: The mean follow up period was 5.7 +/- 3.2 years, ranging from 3 months to 10 years. Six patients showed 3 score of House-Brackmann recovery of facial nerve function in long-term follow-up and the last 2 patients still need time for their final House-Brackmann evaluation.

Conclusions: Surgery should be performed if serial electroneurography and electromyography demonstrate more than 90% degeneration and total denervation potentials, respectively, of nerve fibers. Based on the outcomes observed, late facial nerve decompression may have still beneficial effects in patients who could not be operated on early.