Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study

Subtotal Petrosectomy: Pictorial Review of Clinical Indications and Surgical Approach

Subtotal petrosectomy (STP) is characterized by obliteration of the middle ear and occlusion of the external auditory canal. The advent of the endoscope has allowed a reduction in morbidity for some conditions such as cholesteatoma and other middle ear disorders, but STP still plays an important role. A retrospective review of medical records and videos of patients who had undergone STP was performed. Perioperative data and images were collected from various clinical cases who had undergone subtotal petrosectomy at our tertiary referral university hospital in Verona. We confronted our experience with a review of the literature to present the main indications for this type of procedure. STP allows a variety of diseases to be managed effectively as it offers the possibility of a definitive healing with radical clearance of temporal bone. Moreover, it can be safely combined with other procedures with a very low complication rate. Although the endoscope represents a revolution in ear surgery, STP, when indicated, is nowadays a surgical option that should be included in the otosurgeon's portfolio.

Surgical and nonsurgical treatment outcomes in traumatic facial nerve palsy

PURPOSE

Facial nerve decompression surgery is performed on patients with immediate, complete traumatic facial palsy. However, the clinical advantage of the surgical treatment has weak evidence because of lack of control groups in previous studies. Therefore, this study compared facial function outcomes between the patients who underwent surgery and those who did not. Furthermore, in cases of bilateral traumatic facial palsy, the outcomes of the surgical and nonsurgical sides were also discussed.

METHODS

A retrospective medical chart review of immediate and severe (House-Brackman [HB] grade V and VI) traumatic facial palsy was conducted. Twenty-five ears from the surgical group and eight ears from the conservative treatment group were enrolled. Among the patients, three with immediate and severe bilateral facial palsy underwent unilateral surgery.

RESULTS

The average HB grade after 1-year follow-up was 1.7 in the surgical group and 1.5 in the nonsurgical group. Four patients who have definite facial canal disruption in the imaging study have recovered to HB grades I-III without surgical intervention. In patients with bilateral facial palsy, the nonsurgical side showed the same or better facial functions than the surgical side.

CONCLUSIONS

Compared with nonsurgical conservative treatment, facial nerve decompression surgery did not show superior outcomes in immediate HB grade V-VI traumatic facial palsy. The clinical advantage of facial nerve decompression is questionable and should be re-evaluated in a prospectively designed study.

A case of facial nerve palsy caused by severe head injury treated by translabyrinthine approach

Background

Several treatments for traumatic facial paralysis have been reported, but the role of surgery is still controversial.

Case Description

A 57-year-old man was admitted to our hospital with head trauma due to a fall injury. A total body computed tomography (CT) scan showed a left frontal acute epidural hematoma associated with a left optic canal and petrous bone fractures with the disappearance of the light reflex. Hematoma removal and optic nerve decompression were performed immediately. The initial treatment was successful with complete recovery of consciousness and vision. The facial nerve paralysis (House and Brackmann scale grade 6) did not improve after medical therapy, and thus, surgical reconstruction was performed 3 months after the injury. The left hearing was lost entirely, and the facial nerve was surgically exposed from the internal auditory canal to the stylomastoid foramen through the translabyrinthine approach. The facial nerve's fracture line and damaged portion were recognized intraoperatively near the geniculate ganglion. The facial nerve was reconstructed using a greater auricular nerve graft. Functional recovery was observed at the 6-months follow-up (House and Brackmann grade 4), with significant recovery in the orbicularis oris muscle.

Conclusion

Interventions tend to be delayed, but it is possible to select a treatment method of the translabyrinthine approach.

Effectiveness of Surgical Treatment in Traumatic Facial Paralysis

INTRODUCTION

In the etiology of facial nerve palsy, trauma is the most important. Our aim was to present our experience gained by evaluating the surgical approaches we have used in extratemporal and intratemporal facial nerve injuries and their long-term results, also to contribute to the consensus that will be formed on this subject.

MATERIALS AND METHODS

Thirteen patients among 24 patients who underwent surgery with a diagnosis of traumatic facial paralysis were evaluated in this study. The clinical response of these patients to treatment was examined by classifying them according to the House-Brackmann classification in the preoperative and postoperative periods.

RESULTS

Of the 13 patients, 9 had fractures due to temporal bone trauma, and 4 had nerve damage in the extratemporal part of the facial nerve. In the treatment, facial nerve decompression was performed using the middle fossa approach in 9 patients with temporal bone fractures. In the 4 patients with extratemporal facial nerve injury, graft repair or primary suturing was performed. In the postoperative period, the stages of the patients were III or below in 12 patients (92%), and only 1 (8%) patient remained in stage IV.

DISCUSSION

When the postop conditions of the patients were examined according to House-Brackmann staging, it was observed that surgical treatment caused a significant improvement in the functions of the facial nerve.

CONCLUSIONS

Our results showed that surgery was an effective treatment method in patients with indications for traumatic facial paralysis.

Outcomes of ossicular disruption in traumatic facial paralysis: a case series

BACKGROUND

As tympanotomy using the transcanal approach was a routine surgical technique for traumatic ossicular disruption, the efficacy of the posterior tympanum approach was rarely explored.

AIM

This study aimed to investigate whether the hearing outcomes improved after simultaneous ossiculoplasty and facial nerve decompression using the posterior tympanum approach compared with the transcanal approach.

MATERIAL AND METHODS

The data of 11 patients who underwent ossiculoplasty and facial nerve decompression using the posterior tympanum approach and 21 patients who underwent ossiculoplasty via transcannal approach were analyzed.

RESULTS

The average air-bone gap (ABG) of patients undergoing posterior tympanotomy showed a statistically significant improvement. Postoperative ABG within 20 dB was observed in 81.8% of patients in the posterior tympanum group and 76.2% of patients in the transcanal group. However, the ABG closure in the two groups was not statistically different.

CONCLUSIONS AND SIGNIFICANCE

Simultaneous ossiculoplasty using the posterior tympanum approach was practical, and the hearing outcomes were promising for the patients with traumatic facial nerve paralysis and ossicular disruption.

Surgical anatomy of the facial nerve: from middle cranial fossa approach to endoscopic approach. A pictorial review

PURPOSE

The pathology of the facial nerve is extremely varied and extensive knowledge of the surgical anatomy in different approaches is required to manage it. During the last 15 years, the development of endoscopic ear surgery has significantly changed anatomical concepts, introducing new surgical approaches. The aim of this review is to illustrate five different surgical approaches to the facial nerve: the endoscopic approach, the middle cranial fossa approach, two translabyrinthine approaches (one simple and one endoscopic-assisted) with decompression of the whole petrous portion of the facial nerve, and a transotic approach with temporal craniotomy.

METHODS

Representative cases of middle and/or inner ear pathologies, surgically treated at our ENT Department, were selected to illustrate each of the five different approaches involving the facial nerve throughout its course.

RESULTS

In all cases, the pathology was removed with effective decompression of the facial nerve. The surgical anatomy in each surgical approach is described and illustrated.

CONCLUSIONS

Facial nerve surgery is challenging for ENT specialists. An excellent knowledge of facial nerve anatomy is needed to eradicate pathology, avoiding nerve injuries and providing a good outcome after surgery.