Abstract
Background: Our tertiary otology center treats facial weakness and paralysis after motor vehicle crashes. We evaluate these patients with physical exam, audiogram, Schirmer's test, and CT scan. Our protocol for management of the facial weakness provides good results for our patients.Methods: Our protocol begins with oral steroids, and serial evaluations. Indications for decompression and our unique transcanal approach to identify the sites for decompression are described. A retrospective review of the medical record presents our patients treated between 1998 and 2017.Results: One hundred and forty one patients with grade 4 or more weakness underwent decompression. Mean pre-operative and post-operative House-Brackmann (HB) scores were HB5 and HB2, respectively. Fourteen of 104 patients (13%) presenting with HB5 and 6 still had HB5 or HB6 after decompression. Eighty-three of thee 104 patients (80%) achieved HB1 or HB2 at 6 months. Post-operative bone levels were unchanged. Post-operative air levels were improved in cases of perigeniculate fractures (84%).Conclusion: This Bangalore protocol facilitates advantageous improvement in facial function and conductive hearing loss after traumatic facial nerve crush injuries. The surgical technique, albeit challenging, helps identify the fracture lines, facilitates reconstruction of disrupted ossicles, and avoids craniotomy.
Highlights
Facial nerve injury after temporal bone fracture usually involves the perigeniculate ganglion area [1, 2]
Post-operative air levels were improved in cases of perigeniculate fractures (84%)
Shown are the segment involved by fracture and their HB scores pre-operatively and 6 months post-operatively
Summary
Facial nerve injury after temporal bone fracture usually involves the perigeniculate ganglion area [1, 2]. Our decision tree selects whom to explore, and our transcanal approach to the facial nerve exposes the labyrinthine portion of the nerve through the first genu and geniculate ganglion, tympanic segment, second genu, and mastoid segment. This approach enables the surgeon to follow the fracture course directly to the site of lesion, enables addressing the ossicles which are often disrupted in trauma, and avoids craniotomy. Our tertiary otology center treats facial weakness and paralysis after motor vehicle crashes We evaluate these patients with physical exam, audiogram, Schirmer’s test, and CT scan. Our protocol for management of the facial weakness provides good results for our patients
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