Efficacy of Surgical Treatment in Patients with Post-traumatic Facial Nerve Palsy

Introduction: The most common mechanism of post-traumatic facial nerve palsy are road accidents and falls. Treatment schemes as well as proper timing of surgery are still controversial. Purpose: The aim of the study was the evaluation of the effects of surgical treatment in patients with post-traumatic facial nerve palsy. Treatment results were correlated with epidemiological factors, mechanism of injury, level of nerve damage, time of surgery and its extent. Material and methods: 9 patients with facial nerve palsy after head trauma were analyzed. In all patients complete paresis of the VII nerve occurred immediately after the injury. In 5 patients the nerve was damaged in the course of the longitudinal fracture of the temporal bone, in 3 as a result of its transverse fracture while in one woman there was no evident fracture line. In all cases, surgical treatment was performed between 4 days and 13 weeks after the trauma. In all cases transmastoid approach was used. Edema lesions of the nerve dominated in 6 patients, in two cases a bone fragment was noted along its course, in one person nerve was disrupted but primary reconstruction was not possible - the man was excluded from further analysis. The results of treatment were assessed by House'a-Brackmann (HB) scale 12 months after the procedure. Results: Very good (HBI) or good (HBII) recovery of facial nerve function was achieved in 2 and 4 out of 8 patients respectively. Surgical timing, the extent of surgery, patient’s age, mechanism of injury and level of nerve damage had no effect on the final outcome. Conclusions: The management of post-traumatic facial nerve palsy should be individual. The commonly accepted recommendation on surgical treatment is to undertake it in patients with immediate-onset and complete paralysis. Patients who, due to their severe general condition, cannot undergo early facial nerve decompression may benefit from delayed treatment for up to 3 months after the injury. KEY WORDS: facial nerve palsy, facial nerve decompression, craniofacial injury, temporal bone fracture

Segmental Facial Nerve Decompression in Patients of Chronic Suppurative Otitis Media with Diabetes Mellitus

Introduction: Facial nerve decompression is opening the bony canal and nerve sheath to release pressure and reduce compression on nerve fibers. The goal of decompression is to improve blood circulation and minimize damage to distal nerve fibers. Methodology: We present study of 20 patients who came to ENT OPD, From June, 2017 –March, 2020 presented to us with non-traumatic facial palsy grade III and above; in whom we did facial nerve decompression via trans-mastoid approach. Conclusion: Segmental decompression of facial nerve with masoidectomy provides better results than mastoidectomy alone because it enables expansion of nerve, reduces post-operative oedema and less need for steroid administration in diabetic patients with better clinical outcome.