Facial Nerve Decompression Surgery with Gelatin Containing bFGF

Abstract

Objective: Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. Our experimental study suggested that bFGF-impregnated biodegradable gelatin hydrogel facilitates regeneration of the facial nerve in guinea pigs due to the sustained release of bFGF. Clinically, this therapeutic regimen may be useful for facial nerve decompression surgery. Method: Twenty-five patients with severe facial paralysis were treated with the new procedure. The facial nerve was decompressed tympanic and mastoid portions via mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated once per month by observing the facial movement. Results: Patients were followed until complete recovery occurred, or for more than 6 months in cases with a poor prognosis. All patients with severe Bell’s palsy and Ramsey Hunt syndrome showed early recuperation and milder sequelae compared to conventional decompression surgery. Recovery from the palsy was defined as House-Brackmann grading 1 and 2. The rates of recovered patients with novel surgery and conventional surgery were 92.0% (n = 25) and 70.7% (n = 58), respectively; the former was significantly better than the latter ( P < .05). Conclusion: This is the first study to reveal the efficacy of a bFGF-impregnated biodegradable gelatin hydrogel as a drug-delivery medium in the paralyzed facial nerve surgery. Advantages of this decompression surgery are low risk of hearing impediment and long effective period after onset of paralysis.