Surgical Intervention For Facial Paralysis In Temporal Bone Fracture

Objective:There are dispute in surgical intervention for facial paralysis caused by temporal fracture. In this article, we review related researches and analysis the clinic data we collected, to discuss the indication of facial nerve surgery, the best time and approach of operation, as well as prognostic factors.Methods:A retrospective analysis of38patients with facial nerve paralysis resulting from temporal bone fracture, who underwent decompression surgery or facial nerve transplantation. Evaluation of facial nerve function by House-Brackmann nerve grade system, chi-square test is used to analyze the data.Results:Normal or subnormal facial nerve function (HB1or HB2) is considered to be good functional result.21in38(55.3%) patients got good result,36(94.7%) received Ⅰ～Ⅱ grade recovery. In cases of long-standing (>3weeks) facial paralysis,6in8of degeneration beyond90%recovered to H-B grade Ⅱ, while9in22who degenerate less than90%recovered to grade Ⅱ, EMG test and CT are more helpful for prognosis in cases of long-standing facial paralysis. Patients13in18(72.2%) whose nerve sheath is intact received good recovery, while defective ones8in20(40%) received good results. There were12/21longitudinal fractures,5/9transverse fractures and4/7mixed factures, who at last had Ⅰ～Ⅱ grade recovery, there is no significant statistical difference in different fracture types. Moreover, comparing facial nerve decompression within3months of injury to beyond3months of injury, recovery to H-B Ⅰ～Ⅱ nerve function was59.5%and0%, the statistical difference is significant (P<0.05). We chose middle cranial fossa approach facial decompression for34 patients depending on the results of CT and Schirmer Tear Test,30of them were found lesions at Geniculate Ganglion, and18of them recovered to H-B Ⅰ～Ⅱ,14recovered to Ⅲ.Conclusion:Facial decompression is effective in treating facial paralysis caused by temporal fracture. Most lesions happen in the area of GG, while middle cranial fossa approach can give best exposure of these areas, for most patients, we chose this approach for the surgery. While lesions set in GG, local decompression is carried out, and most traumatic facial paralysis patients recovered to H-B Ⅱ, there is no need for total decompression. Surgery carried out beyond3months did not receive good recovery, so the operation should be performed in3months.