Surgical and nonsurgical management of facial paralysis following closed head injury.

The outcomes of facial nerve decompression, surgical exploration, and nonsurgical treatment for facial paralysis following closed head injury were analyzed in 30 patients with an intact facial nerve, and complete evaluation. Objective evaluation of outcome was achieved by calculation of a Facial Paralysis Recovery Profile and Recovery Index (Profile minus complications). Twelve of 15 patients with incomplete facial paralysis were treated medically. All followed patients with incomplete paralysis and bilaterally equal facial nerve excitability had a Recovery Index of + 10 (complete recovery of function, no complications). Three with partial denervation had a Recovery Profile of + 10 with mild contracture and synkinesis. The average Recovery Profiles for all patients treated by decompression, exploration, or nonsurgically were respectively 4.0, 5.7, and 5.7. The Recovery Indices were +1.8, +3, and +2.7, respectively. Where nerve excitability had become abnormal, facial nerve decompression was of no benefit in traumatic facial paralysis due to closed head injury. Nerve excitability tests of peripheral branches are of great value for prognosis and selection of patients who do not need surgical intervention. Substitution of facial nerve exploration for facial nerve decompression seems reasonable. Polytomography of the facial canal is invaluable in selection of patients for operation.