Surgical Management of Peripheral Facial Paralysis due to Temporal Bone Fractures

Abstract

Aim: The aim of this study is to report the results of our facial nerve decompression series and to define predictive factors on postoperative outcomes in temporal bone fractures.

Methods: Between May 2011 and July 2019, facial nerve decompression surgery was performed in 18 patients. Patients were operated by either transmastoid extralabyrinthine or transmastoid translabyrinthine route considering fracture location and hearing status. Audiologic evaluation was performed in all patients preoperatively and at the third month after operation.

Results: 15 males and 3 females were included in this study, whose ages ranged from 1 to 47 years (mean: 16.6 years). Twelve (66.6%) of the patients were operated within the first month. Three (16.7%) were operated later than 3 months. The most common cause of the temporal bone fracture was motor vehicle crash (9 patients, 50%), followed by television tipover (4 patients, 22.2%). Eleven (61.1%) of the fractures were violating the otic capsule. House-Brackmann (HB) grade 1 or 2 postoperative facial nerve functions were obtained in 14 (77.7%) patients. Patients who were operated within the first three months showed a significantly better progress in HB scores (p=0.002). There was a significant correlation between otic capsule involvement and the type of hearing loss (p<0.001).

Conclusion: Delayed surgical intervention for more than 3 months and involvement of labyrinthine portion of the facial nerve negatively affected the postoperative recovery of facial functions. Involvement of the otic capsule was significantly related with the type of hearing loss.