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 . 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 . 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 . Darrouzet et al. have
V. Darrouzet, J. Y. Duclos, D. Liguoro, Y. Truilhe, C. de Bonfils, and J. P. Bebear, “Management of facial paralysis resulting from temporal bone fractures: our experience in 115 cases,” Otolaryngology-Head & Neck Surgery, vol. 125, no. 1, pp. 77–84, 2001.
T. Ulug and A. S. Ulubil, “Management of facial paralysis in temporal bone fractures: a prospective study analyzing 11 operated fractures,” American Journal of Otolaryngology, vol. 26, no. 4, pp. 230–238, 2005.
A. Quaranta, G. Campobasso, F. Piazza, N. Quaranta, and I. Salonna, “Facial nerve paralysis in temporal bone fractures: outcomes after late decompression surgery,” Acta Oto-Laryngologica, vol. 121, no. 5, pp. 652–655, 2001.
G. Z. Sanus, T. Tanriverdi, N. Tanriover, M. O. Ulu, and M. Uzan, “Hearing preserved traumatic delayed facial nerve paralysis without temporal bone fracture: neurosurgical perspective and experience in the management of 25 cases,” Surgical Neurology, vol. 71, no. 3, pp. 304–310, 2009.
J. S. Sillman, J. K. Niparko, S. S. Lee, and P. R. Kileny, “Prognostic value of evoked and strandard electromyography in acute facial paralysis,” Otolaryngology-Head & Neck Surgery, vol. 107, no. 3, pp. 377–381, 1992.
N. J. Coker, K. A. Kendall, H. A. Jenkins, and B. R. Alford, “Traumatic intratemporal facial nerve injury: management rationale for preservation of function,” Otolaryngology-Head & Neck Surgery, vol. 97, no. 3, pp. 262–269, 1987.
M. Pellicer and P. Quesada, “The use of a CT scan to predict the feasibility of decompression of the first segment of the facial nerve via the transattical approach,” Journal of Laryngology and Otology, vol. 109, no. 10, pp. 935–940, 1995.
M. D. Graham and J. L. Kemink, “Total facial nerve decompression in recurrent facial paralysis and the Melkersson-Rosenthal syndrome: a preliminary report,” American Journal of Otology, vol. 7, no. 1, pp. 34–37, 1986.
R. F. Bento, S. Pirana, R. Sweet, A. Castillo, and R. V. Brito Neto, “The role of the middle fossa approach in the management of traumatic facial paralysis,” Ear, Nose and Throat Journal, vol. 83, no. 12, pp. 817–823, 2004.