The effect of surgical timing on functional outcomes of traumatic facial nerve paralysis.
BACKGROUND
The optimal timing for surgical exploration of traumatic facial paralysis to best preserve facial function is currently controversial. This article reviews the final outcomes of facial function in patients with traumatic intratemporal facial nerve injury according to the timing of surgical exploration.


METHODS
We performed a retrospective review of 58 patients with complete facial nerve paralysis caused by temporal bone fractures as a result of head trauma between 1998 and 2007. Patients were divided into three groups according to the type of trauma. The only difference between patients in each group was the timing of the surgical exploration. Characteristics assessed in the study included type of trauma, location of facial nerve injury, timing of surgical intervention, audiometric findings, surgical approach, and long-term follow-up of recovery of facial nerve function, as assessed by two facial nerve grading systems.


RESULTS
The final functional gains in early-operated patients were 3.7 +/- 0.59 on the House-Brackmann (HB) scale and 75.6 +/- 10.88 on the Sunnybrook scale. The outcome in late-operated patients was 2.17 +/- 0.52 on the HB scale and 34.7 +/- 16.95 on the Sunnybrook scale, and that of nonoperated patients was 2.0 +/- 0.63 on the HB scale and 26.8 +/- 6.27 on the Sunnybrook scale.


CONCLUSIONS
This study demonstrated that some patients with traumatic facial nerve paralysis who had nerve conduction studies consistent with a poor prognosis regained considerable facial function after early surgical intervention. However, late exploration after facial nerve paralysis did not result in positive outcomes, regardless of the type of temporal bone fracture or the site of injury, and no difference was observed compared with conservative treatment.
Kim
Jin
J
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
Moon
In Seok
IS
Shim
Dae-Bo
DB
Lee
Won Sang
WS
D004576:Electromyography; D020220:Facial Nerve Injuries / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D005158:Facial Paralysis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013701:Temporal Bone / Q000293:injuries / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome