A retrospective analysis of facial palsy in patients of squamosal chronic suppurative otitis media with diabetes mellitus

Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House– Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.

Surgical outcomes of transmastoid facial nerve decompression: Preliminary data from a Malaysian tertiary hospital from 2013-2018

@#Introductions: Facial nerve palsy (FNP) occurs in 7-10% of temporal bone fractures. The aim of this study was to review the surgical outcome of nine patients with severe to complete traumatic facial nerve (FN) injury. Methods: The patients were evaluated clinically and FNP was graded using the House Brackmann (HB) scale. High resolution computerized tomography (HRCT) of the temporal bone was used to evaluate temporal bone fractures. Transmastoid facial nerve decompression was performed and the facial nerve function was re-evaluated in subsequent follow ups. Results: There were five cases with immediate onset and four with delayed onset of FNP. Only three cases had pure temporal bone fractures, the others were associated with other life threatening injuries. The sensitivity and specificity of HRCT temporal bone to detect the obvious facial canal fracture line were 50% and 40% respectively. 75% of patients with immediate onset of HB grade VI FN palsy who were operated within a month recovered completely. Surgeries for the delayed onset FNP were performed at a mean of 70 days (range 51-94). All recovered to HB grade II-III from severe FNP. Conclusions: Our study demonstrated that transmastoid FN decompression surgery was beneficial to traumatic nerve injury. Early intervention resulted in better outcomes. However, FN function could still be salvaged even in delayed FN decompression.

Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis

We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell's palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May's classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May's classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell's palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.

Advance in Facial Nerve Decompression for Facial Palsy Resulting from Zygomatic Fractures (review) / 中国康复理论与实践

@#The facial nerve is the longest nerve shaped the bone tube, which has many turnings and narrow path. About 7% to 10% of patients with temporal bone fracture have facial paralysis. Most of the patients showed loss of frontal lines, inability to close eyes, and deflection of the teeth. Facial nerve decompression has been an effective way to relieve the symptoms and restore facial nerve functions. However, the issue of surgical indications, timing of surgery, and scope of decompression still need further research.

Facial nerve decompression in treatment of patients with early peripheral traumatic facial paralysis / 局解手术学杂志

Objective To explore the effect of facial nerve decompression via mastoid-epitypanum approach on the treatment of early peripheral traumatic facial paralysis caused by temporal bone fracture.Methods The data of 21 patients with early peripheral traumatic facial paralysis caused by temporal bone fracture in our hospital from October 2011 to June 2016.The facial nerve electrogram and the blink reflex of the injured facial nerve of 21 patients who treated facial nerve decompression via mastoid-epitypanum approach were compared before and after operation.The degree of facial nerve function recovery was evluated by H-B grading method.Results The facial nerve function of all patients had improved in different degrees,85.7% patients recovered to Ⅰ~Ⅱ level.Compared with those before operation,the latency,amplitude and latent period of blink reflex of the ipsilateral facial electroneurography were significantly improved(P<0.05).Conclusion The facial nerve decompression has good effect in the treatment of early peripheral traumatic facial paralysis.

Surgical treatment of facial nerve palsy:an analysis of the operation efficacy in 29 patients / 中国基层医药

Objective To evaluate the effect of surgical treatment in facial nerve paralysis.Methods Clinical data of 29 cases in facial nerve paralysis were retrospectively analyzed.All of the 29 cases of facial paralysis,18 cases is the suppurative otitis media,9 cases is the temporal bone fracture,2 cases is the neoplasms of the temporal bone.The 29 cases of facial nerve paralysis were surgical treatment.8 cases by vertical segment or horizontal segment of facial nerve decompression,19 cases by the stylomastoid foramen to the geniculate ganglion of facial nerve decompression,2 cases by the itratemporal course of facial nerve decompression.1 case was underwent end-to-end anastomosis,2 cases of the greater auricular or the sural nerve graft for repairing facial nerve defect.All data were analyzed with Rank sum test.Results Makes a follow-up visit for 6～18 months,the facial nerve function(House-Brackman grading system)before the technique Ⅱ 6.9%,Ⅲ17.2%,Ⅳ34.5%,Ⅴ 31.0%,Ⅵ 10.3%,after the technique,restores Ⅰ 6.9%,Ⅱ27.6%,Ⅲ27.6%,Ⅳ 24.1%,Ⅴ 13.8%,statistics analysis facial nerve function restoreS has the significance difference(P＜0.005).Conclusions The facial nerve decompression and the nerve graft are useful method to treat facial paralysis.Surgical treatment of facial paralysis is satisfied in the suppurative otitis media and the temporal bone fracture.

Facial Nerve Decompression via Middle Fossa Approach: Report of Three Cases

OBJECTIVE: Several conservative treatments have been tried in peripheral facial nerve paralysis, because 80% of patients recover spontaneously. Surgical decompression may be helpful to the residual, medically intractable patients. We present here our experiences of facial nerve decompression via middle fossa approach, which seems to be one of good surgical therapeutic options for medically refractory peripheral facial nerve paralysis. METHOD:Three cases of medically intractable peripheral type facial paralysis were microscopically operated via middle cranial fossa approach to decompress the labyrinthine segment of the facial nerve and geniculate ganglion by searching landmarks of middle meningeal artery, greater superficial petrosal nerve and facial hiatus. RESULTS: After operation, two cases of Bell's palsy improved substantially and one case of post-traumatic facial paralysis improved partially. CONCLUSION: This report is presented to describe the surgical facial nerve decompression via middle fossa for early control of peripheral type facial paralysis. Surgical decompression of edematous peripherally paralysed facial nerve could be preferred to conservative treatment in some patients although more surgical experience should be required.

Report of facial nerve decompression in the traumatic facial palsy

Return of facial nerve function is important in patients with facial nerve paralysis by trauma. Sometimes, delay in diagnosis of facial nerve paralysis make recovery of facial nerve function difficult. Traumatic facial palsy mostly occur after temporal bone fracture in unilateral. Temporal bone fracture after head trauma are divided into the three group; longitudinal fracture, transverse fracture and mixed fracture. The most common symptoms are hearing impairment, bloody otorrhea, loss of consciousness and facial nerve paralysis. The early care of temporal bone fracture involves facial nerve paralysis. And there has been many discussion and study in the treatment of the immediate or delayed facial palsy ; examply, surgical approach, time and methods. We have managed a patient with unilateral facial nerve paralysis after longitudinal temporal bone fracture in mastoid process and conservative facial nerve decompression was performed. We have obtained good result and report this case with review of literatures.