Darrouzet V, de Bonfils-Dindart C, Bébéar J P
Clinique Universitaire ORL, CHU, Bordeaux.
Neurochirurgie. 1998 Nov;44(4):235-46.
To review patient selection and factors affecting the decision for surgical or non-surgical management of patients with trauma-induced facial nerve palsy.
Retrospective review of 85 consecutive cases occurring over a 6-year period.
Between 1984 and 1990, 85 cases of facial nerve palsy following trauma were treated. Patient assessment included clinical, audiological, radiological and EMG examinations. Depending on test results, patients were either given medical treatment or underwent total facial nerve decompression surgery.
Recovery was achieved in all 33 medically treated patients. Among the 52 surgically-treated patients (61.2%), 47 had immediate facial nerve palsy at admission (90.4%). Onset of facial palsy was delayed in 5 others, including 3 for whom the delay to onset was unknown. Surgical accesses used were the middle fossa and transmastoidal (60%), translabyrinthine (11%), and pure transmastoidal (29%) routes depending on hearing loss, location of fracture line and general patient condition. Lesions were predominantly found in the geniculate ganglion area. A nerve gap was found in only 13.5% of the cases. Two years post-operatively, 92.3% of the patients had grade I-III recovery. No grade V or VI cases were observed.
The rarity of severe nerve lesions encountered in surgically-treated patients raises the question of better candidate selection for surgery. At present, imaging techniques, particularly radiology, can help to choose the best indication. Immediate total facial palsy associated with a clear-cut fracture going through the Fallopian canal is perhaps the only case requiring surgery. When the delay of onset is unknown, an EMG indicating a total denervation process is the decisive argument.
