Management of facial paralysis resulting from temporal bone fractures: Our experience in 115 cases.
OBJECTIVE
The goal of this study was to review decision factors and overall results regarding surgical and nonsurgical management of post-traumatic facial nerve paralysis (FP).


METHODS
A retrospective study and literature review were performed.


METHODS
Between 1984 and 1990, 115 cases of post-traumatic FP were handled. Patients were evaluated through clinical, audiologic, radiologic, and electromyogram assessment. Depending on examination results, patients were treated either medically or surgically through total facial nerve decompression.


RESULTS
Forty-nine of the 50 medically treated patients experienced a normal or subnormal facial function recovery (grade I-II). Of the 65 (56.5%) surgically treated patients, 52 (80%) had immediate, 2 had delayed, and 11 (17%) had unknown delay-associated FP. The approaches chosen were middle fossa and transmastoid (75.3%), translabyrinthine (10.7%), or pure transmastoid according to facial nerve nonmotor branch evaluation, hearing, location of the fracture line, and the patient's general condition. Lesions were predominantly found in the geniculate ganglion area (66.2%). A nerve gap was found in only 13.8% of the cases. At 2 years after surgery, 93.8% had a grade I to III recovery. None had grade V or VI.


CONCLUSIONS
The rarity of severe nerve lesions encountered in surgically treated patients raises the question of better selection of candidates for surgery. Surgery is clearly indicated when FP is total, is of immediate onset, and is associated with a bad prognosis electromyogram pattern. In other settings, decisions are to be made based on high-resolution CT data and electromyogram results, thanks to a clinical survey and second electromyogram evaluation.
Darrouzet
V
V
Department of Otorhinolaryngology, University Hospital of Bordeaux, France. vincent.darrouzet@chu-bordeaux.fr
Duclos
J Y
JY
Liguoro
D
D
Truilhe
Y
Y
De Bonfils
C
C
Bebear
J P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000379:methods; D004576:Electromyography; D005158:Facial Paralysis / Q000209:etiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D026741:Physical Therapy Modalities / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D008775:Methylprednisolone