Total Facial Nerve Decompression for Severe Traumatic Facial Nerve Paralysis: A Review of 10 Cases

Management of traumatic facial nerve disorders is challenging. Facial nerve decompression is indicated if 90–95% loss of function is seen at the very early period on ENoG or if there is axonal degeneration on EMG lately with no sign of recovery. Middle cranial or translabyrinthine approach is selected depending on hearing. The aim of this study is to present retrospective review of 10 patients with sudden onset complete facial paralysis after trauma who underwent total facial nerve decompression. Operation time after injury is ranging between 16 and105 days. Excitation threshold, supramaximal stimulation, and amplitude on the paralytic side were worse than at least %85 of the healthy side. Six of 11 patients had HBG-II, one patient had HBG-I, 3 patients had HBG-III, and one patient had HBG-IV recovery. Stretch, compression injuries with disruption of the endoneurial tubules undetectable at the time of surgery and lack of timely decompression may be associated with suboptimal results in our series. 1. Introduction Indication and timing of the facial nerve decompression for facial paralysis and the anatomical extent of decompression has been a subject of controversy for years. Studies indicate that the number of surgical interventions has decreased over decades. In an analysis of large volume of published data between 1966 and 1999 regarding the management of facial nerve injury due to temporal bone trauma, Chang and Cass have reported that the patients with normal facial nerve function after injury regardless of progression, those with presentation of incomplete paralysis with no progression to complete paralysis, and those with less than 95% degeneration on ENoG at initial admission usually do not require surgical intervention. However, they have also reported that no data were available to provide information on exactly how much the return of function will be for the remaining patients who presumably have poorer prognosis [1]. Brodie and Thompson have reviewed 58 facial nerve injuries and reported that all patients with incomplete paralysis in the beginning recovered and 8 of 9 patients with delayed and 3 of 5 patients with sudden onset facial paralysis recovered after surgical decompression. But 2 of those (40%) patients with immediate-onset complete paralysis presented poor prognosis [2]. McKennan and Chole have compared recovery of patients with delayed and immediate-onset traumatic facial paralysis and have found that recovery is likely to occur in 94% of delayed-onset facial paralysis without surgical intervention [3]. Darrouzet et al. have