Nonsurgical Treatment for Posttraumatic Complete Facial Nerve Paralysis.

Importance: Current recommendations envisage early surgical exploration for complete facial nerve paralysis associated with temporal bone fracture and unfavorable electrophysiologic features (response to electroneuronography, <5%). However, the evidence base for such a practice is weak, with the potential for spontaneous improvement being unknown, and the expected results from alternative nonsurgical treatment also undefined. Objective: To document the results of nonsurgical treatment for posttraumatic complete facial paralysis with undisplaced temporal bone fracture and unfavorable electrophysiologic features. Design, Setting, and Participants: Prospective cohort study recruiting from April 2010 to April 2013 at a tertiary care university hospital. Follow-up continued until 9 months or until complete recovery if earlier. Study group included 28 patients with head injury-associated complete unilateral facial nerve paralysis with unfavorable results of electroneuronography (<5% response) with or without undisplaced temporal bone fracture. Undisplaced temporal bone fractures were documented in 26 patients (24 longitudinal fractures and 2 transverse fractures). Interventions: Patients received prednisolone, 1 mg/kg, for 3 weeks combined with clinical monitoring every 2 weeks and electromyography monitoring every 4 weeks. As per study protocol, surgical exploration was limited to patients demonstrating motor end plate degeneration on results of electromyography, or having no improvement until 18 weeks. Main Outcomes and Measures: Facial nerve function was evaluated by the House-Brackmann grading system; Forehead, Eye, Mouth, and Associated defect grading system; and the modified Adour system. Observations were completed at 40 weeks. Results: Among the 28 patients in the study (3 women and 25 men; mean [SD] age, 32.2 [8.7] years), facial nerve recovery with conservative treatment alone was noted in all patients. No recovery was seen in any patient at the initial 4-week review. The first signs of clinical recovery were noted in 4 patients by 8 weeks, in 27 patients by 12 weeks, and in all patients by 20 weeks. No patient required surgical exploration. At 40 weeks, 27 patients recovered to House-Brackmann grade I/II and 1 patient to grade III. All 24 patients with longitudinal fractures had grade I/II recovery. Conclusions and Relevance: For undisplaced temporal bone fractures, nonsurgical treatment leads to near-universal recovery to House-Brackmann grade I/II and is superior to reported surgical results. Recovery is delayed and usually first manifests at 8 to 12 weeks after the fracture. In the current era of high-resolution computed tomography, surgical exploration should not be first-line treatment for undisplaced longitudingal temporal bone fractures associated with complete facial nerve paralysis and unfavorable electrophysiologic features.

Diplopia as a sequel of unilateral neck dissection.

BACKGROUND: The purpose of this study was to discuss the underlying etiology of raised intracranial pressure and its sequel after unilateral internal jugular vein ligation. In addition, the management protocol for such rare cases has been discussed along with literature review. METHODS: PubMed and Google were used to search the literature for cases of raised intracranial pressure with complications after unilateral internal jugular vein (IJV) ligation. Twelve case reports with 17 patients were identified. RESULTS: There were 13 male and 4 female patients ranging between the ages of 26 and 61 years. Headache (n = 12/17; 70.5%), diplopia (n = 10/17; 58.8%), impaired vision (n = 9/17; 52.9%), and aplasia or hypoplasia of the transverse sinus were seen in these patients. CONCLUSION: Although very rare, this potential complication after unilateral IJV ligation should be kept in mind. Magnetic resonance venogram (MRV) is the investigation of choice to ascertain the underlying etiology. Conservative management should be started immediately. Surgical options are reserved for patients with progressive symptoms. © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38:E2475-E2478, 2016.