Surgical decompression of the nerve for facial palsy in temporal bone trauma: Insights from a three-decade experience.

Abstract

Aims: To evaluate the surgical outcomes of facial nerve decompression for facial paralysis in temporal bone fractures.

Material and methods: A retrospective review was conducted on 11 patients who underwent surgery for facial paralysis due to temporal bone trauma in our ENT department between March 1994 and July 2024. Inclusion criteria were failure of corticosteroid therapy and persistence of severe facial paralysis. Surgical outcomes were assessed using the House-Brackmann (HB) classification at one year and by monitoring postoperative HB progression. Potential prognostic factors included delay to surgery, intraoperative nerve swelling and response to stimulation with intraoperative facial nerve monitoring (FNM).

Objectives: To analyze functional recovery following facial nerve decompression and to identify clinical or intraoperative predictors of improved outcome.

Results: In our cohort of patients with temporal bone trauma, 27.3% of patients achieved HB I at one year and 90.9% reached HB≤III. Mean HB improvement increased steadily from<1 month (ΔHB 0.89) to 12 months (ΔHB 3.36). No significant difference in recovery was observed between patients operated≤2 weeks and>2 weeks, although all surgeries were performed within 1 month. Intraoperative nerve swelling was not associated with outcome. A detectable intraoperative nerve response showed a trend toward better complete recovery.

Conclusion: Facial nerve decompression yielded favorable functional outcomes, with progressive recovery over one year. Favorable results were observed when surgery was performed within the first month after injury. Intraoperative nerve swelling was not predictive of prognosis, whereas a detectable intraoperative nerve response may have prognostic value. Larger studies are needed to confirm these findings.