[Facial paralysis after temporal bone trauma].
OBJECTIVE
To evaluate functional outcome in 64 cases of facial paralysis following temporal bone fracture and discuss decisive arguments leading either to medical treatment or surgical management.


METHODS
Sixty-four patients suffering from post-traumatic facial paralysis were managed between 1995 and 2003: 38 (59%) were given medical treatment and 26 (41%) underwent surgery. A combined middle fossa and transmastoid approach was mostly used (58%). Electrophysiological testing and CT scan results were the main points of the decision algorithm.


RESULTS
Electroneuromyography seems to be the most accurate exploration for guiding treatment. Good results (grades I to II on the House and Brackmann scale) were obtained in 63% of cases after medical management and in 39% of cases after surgical treatment. Grades III or IV were obtained in 13% of medically-treated patients and 42% of surgically-treated patients.


CONCLUSIONS
Management of facial paralysis following temporal bone fracture in accordance with electrophysiological testing (evoked EMG) together with CT scan findings enabled accurate indications for surgical treatment. A good grade I or II result can be expected after medical management. A grade III is at best reached after nerve anastomosis.
Bodenez
C
C
Service d'ORL et de Chirurgie Cervico-faciale, Centre Hospitalier Universitaire, Place A. Reba Léon, 33076 Bordeaux. camille.bodenez@wanadoo.fr
Darrouzet
V
V
Rouanet-Larriviere
M
M
Barreau
X
X
Liguoro
D
D
Bebear
J-P
JP
Franco-Vidal
V
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001299:Audiometry / Q000379:methods; D002648:Child; D003131:Combined Modality Therapy; D004576:Electromyography; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D013701:Temporal Bone / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy
D000893:Anti-Inflammatory Agents; D011241:Prednisone; D008775:Methylprednisolone