Transmastoid Facial Nerve Decompression Research Articles

Transmastoid Facial Nerve Decompression for Craniometaphyseal Dysplasia.

We document the first successful transmastoid surgical treatment of facial nerve palsy for a patient with craniometaphyseal dysplasia (CMD), a rare genetic disease. A 9-month-old girl with bilateral facial nerve palsies and conductive hearing loss. Genetic testing made a diagnosis of CMD, and imaging showed narrowing of the facial nerve canals and ossicular fixation. Right transmastoid facial nerve decompression and ossicular chain reconstruction. Facial nerve function (House-Brackmann grade). Facial nerve function initially worsened, then improved within 12 months from House-Brackmann grade IV-V to grade III. Surgical cranial nerve decompression of and ossicular chain reconstruction may be effective treatments for patients with CMD.

Frequency-dependent hearing outcomes with or without preservation of intact ossicular articulations.

To determine the frequency-specific benefits of ossicular chain preservation compared to performing disarticulations and reconstructions in transmastoid facial nerve decompression surgery in patients with an intact ossicular chain. A retrospective chart review (January 2007 and June 2018) of patients undergoing transmastoid facial nerve decompression on the intact middle ear for severe facial palsy at a tertiary referral center. Surgery was performed with ossicular chain disarticulation on an as-needed basis using either ossicular chain preservation (without ossicular disarticulation), incudostapedial separation, or incus disarticulation technique. Hearing outcomes were assessed. The 108 patients were included in this study. Among these, 89 patients underwent ossicular chain preservation, 5 underwent incudostapedial separation and 14 underwent incus repositioning. The proportion of patients with a change in the 4-frequency air conduction pure-tone average of less than 10dB was 91%, 60%, and 50%, respectively, for the three surgical techniques; these were significantly different (Fisher's exact test, p < .001). Frequency-specific analysis showed that air conduction was significantly better following the ossicular chain preservation technique compared with the incus repositioning technique at stimulation frequencies lower than 250 Hz and higher than 2000 Hz, and compared with the incudostapedial separation technique at 4000 Hz. Analysis of biometric measures determined on CT images suggested that the feasibility of the ossicular chain preservation technique correlates with incus body thickness on coronal CT images. Ossicular chain preservation is an effective approach for hearing preservation in transmastoid facial nerve decompression or similar surgical procedures.

Management of the facial nerve following temporal bone ballistic injury.

ObjectiveTo understand the patterns of temporal bone fracture and facial nerve injury from ballistic trauma.Study DesignRetrospective case series.MethodsRetrospective review of 42 patients evaluated following temporal bone ballistic injury at a single institution, university‐based level‐one trauma center between 2012 and 2021. Demographics, facial nerve status, CT images, interventions, complications, and outcomes were reviewed.ResultsMean age 30.3 years (range 5–58 years); 79% male. Racial demographics reflected the surrounding community. Seven mortalities occurred. Nineteen patients (54%) demonstrated facial nerve injury. Of those, 13/19 displayed immediate paralysis, 1 delayed, 5 unknown (due to altered mental status). On consultation, House‐Brackmann grade 6 paralysis was common (13/19). Fracture was otic capsule‐sparing in 17/19 (90%), universally comminuted, with significant disruption along the mastoid tip (16/19), external auditory canal (EAC) (15/19), and periauricular soft tissues (13/19). Nine patients underwent surgical intervention: Transmastoid facial nerve decompression to remove compressive bony spicules (n = 5); eye protection surgery (n = 3); and peripheral facial nerve exploration (n = 1), noting transection at the pes. One required middle cranial fossa and transmastoid repair of cerebrospinal fistulae in setting of severe meningitis. House‐Brackmann scores improved in 80% following transmastoid nerve decompression despite CT evidence of likely additional injury in its extratemporal course.ConclusionsCommon patterns of temporal bone fracture seen in blunt trauma (longitudinal/transverse, otic capsule‐sparing/disrupting) were not found in patients with ballistic facial nerve injury. Rather, injury was commonly apparent in the EAC, mastoid tip, and periauricular soft tissues. Clinicians should have high suspicion for extratemporal facial nerve injury following ballistic trauma.

Surgical Outcomes of Transmastoid Facial Nerve Decompression for Patients With Traumatic Facial Nerve Paralysis

Objective:To evaluate the facial nerve function and audiological results of delayed (by at least one month after the insult) transmastoid facial nerve decompression (FND) in traumatic facial nerve paralysis (FNP). Methods: Medical records of 57 patients with traumatic FNP were reviewed and surgical results of 13 patients (mean age 28.0 ± 17.67, range 3-67) undergoing transmastoid FND were analyzed. Preoperative and postoperative mean hearing thresholds were compared using 0.5, 1, 2, and 3 kHz. Facial nerve function was graded according to the House–Brackmann scale (HB) before and after surgery. HB scale results of grade III or better were accepted as good results postoperatively. Results: Preoperative HB grades were V in 5 and VI in 8 patients. Twelve of 13 patients had good recovery of facial nerve function regardless of the operation timing. When mean preoperative and postoperative air–bone gap (ABG) values were compared (except the patients with total sensorineural hearing loss), the mean preoperative ABG was 33 ± 15.9 dB, and mean postoperative ABG was 17.2 ± 8.68 dB. There was a mean hearing gain of 15.8 dB after transmastoid facial nerve decompression surgery. Surgery and anesthesia-related complications were not seen in any patients. Conclusion: The transmastoid route can be used safely and effectively with elimination of the risks of craniotomy and middle fossa surgery for patients with traumatic FNP. Hearing improvement can be achieved by performing ossicular chain reconstruction during decompression surgery for patients with conductive or mixed hearing loss (HL).KEYWORDS: Facial nerve, decompression, facial paralysis

Facial and hearing outcomes in transmastoid nerve decompression for Bell's palsy, with preservation of the ossicular chain.

ObjectivesFacial nerve decompression is a salvage treatment for Bell's palsy patients for whom a poor prognosis is anticipated with standard medical treatment. The transmastoid approach is a frequently performed approach, but it remains unknown if this surgery is effective when the ossicular chain is preserved. This study aimed to determine the efficacy of facial nerve decompression using the transmastoid approach in Bell's palsy.Design, setting and participantsThis retrospective study included patients who had undergone transmastoid facial nerve decompression with ossicular chain preservation and patients who met the criteria for surgery, but received only medical treatment between January 2007 and May 2019, at a single centre.Main outcome measuresAttainment of House‐Brackmann grade I at 12 months after onset of facial palsy.ResultsThe recovery rate to House‐Brackmann grade I in the decompression group in the early phase (≤18 days after onset) was higher than that of the medical treatment group, although the difference was not significant (70% vs 47%, P = .160). However, within this early surgery group, a subgroup of cases with ≥95% facial nerve degeneration demonstrated a significant improvement in recovery rate (73% vs 30%, P = .018). Among surgeries performed in the late phase (≥19 days), only a subgroup with ≥95% facial nerve degeneration was available for analysis, and the difference in recovery rate was not significant compared with medical treatment alone (26% vs 30%, P = 1.00). Post‐surgical hearing evaluation demonstrated that average hearing deterioration was 1.3 dB which was non‐significant, suggesting this procedure does not cause hearing loss.ConclusionsTransmastoid facial nerve decompression with ossicular chain preservation in the early phase after symptom‐onset is an effective salvage treatment for severe Bell's palsy with ≥95% facial nerve degeneration.

Modified Stennert's infusion protocol for posttraumatic delayed facial nerve palsy

Objective: The objective of the study is to validate the role of modified Stennert's infusion protocol in posttraumatic delayed facial nerve palsy. Materials and Methods: A retrospective chart review of 21 patients with delayed onset posttraumatic facial nerve palsy was carried out in a tertiary teaching hospital. All patients with delayed onset facial nerve palsy were treated with modified Stennert's protocol. It is a combination therapy which includes tapering doses of hydrocortisone, pentoxifylline, and low-molecular-weight dextran provided over 13 days. If the patient did not show signs of improvement with modified Stennert's protocol by the 10th day of therapy, they were advised to undergo transmastoid decompression of facial nerve. Analysis was performed based on House–Brackmann (HB) grading performed at the time of diagnosis and after 30 days of follow-up. Improvement was considered to have taken place if HB grading improved by minimum of two or reached normal value of one. Results: Twenty-one patients were started on modified Stennert's protocol of which 15 improved and 6 did not improve. They underwent transmastoid decompression of facial nerve and improved significantly afterward. Conclusion: A trial of modified Stennert's infusion protocols is a safe option in patients with posttraumatic delayed facial nerve palsy.

Delayed transmastoid facial nerve decompression surgery in patients with Ramsay-Hunt syndrome presenting with neurophysiologically complete paralysis

Objectives: To determine the efficacy of delayed transmastoid facial nerve decompression in patients with Ramsay Hunt Syndrome (RHS) presenting with complete facial paralysis.Methods: Twenty-five RHS patients with complete facial nerve paralysis presenting electroneuronographic (ENoG) degeneration ≥90% underwent transmastoid facial nerve decompression more than 3 weeks after the onset of paralysis. The principal features measured were 12 months pre- and post-operative House-Brackmann (HB) grades and the presence of a direct intraoperative neural response (INR) prior to decompression procedure. Correlations between these parameters, and the time between symptom onset and surgery (within or later than 30 and 50 d) were statistically analyzed.Results: Of the 25 patients 13 (52%) exhibited good recovery (HB grade I or II) at 12 months-post-operatively. The timing of decompression generally did not significantly influence outcome but patients treated within 50 d of symptom onset enjoyed better outcomes than those treated later (p = .047). The presence of an INR significantly influenced outcomes (p = .0003).Conclusions: The success of delayed transmastoid facial nerve decompression in RHS patients was not affected between 25–30 and 30–40 d from symptom onset but was compromised when the delay was >50 d. The presence or absence of an INR was a good predictor of post-operative prognosis.

Hearing loss in Peripheral Facial Palsy after decompression surgery

Facial paralysis can result from a variety of etiologies; the most common is the idiopathic type. Evaluation and treatment are particularly complex. The treatment of acute facial paralysis may require facial nerve decompression surgery. Any structure near the path of the facial nerve is at risk during transmastoid decompression surgery. AimThis is a retrospective study, carried out in order to evaluate hearing loss after transmastoid decompression and how idiopathic cases evolved in terms of their degree of paralysis in the last 15 years. Materials and MethodsWe selected the charts from 33 patients submitted to transmastoid facial nerve decompression in the past 15 years and we assessed their hearing loss and facial paralysis. ResultsThere was a high percentage (61%) of patients with some degree of hearing loss after the procedure and in all cases there was improvement in the paralysis. DiscussionThe values obtained are similar to those reported in the literature. One possible explanation for this hearing loss is the vibration transmission by drilling near the ossicular chain. ConclusionThe surgical procedure is not risk free; indications, risks and benefits should be explained to patients through an informed consent form.

Delayed facial nerve decompression for Bell's palsy.

Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90% degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

Modified Surgical Approach in Facial Palsy: It’s Worth a Try

Objective: To evaluate effectiveness of a modified technique of facial nerve decompression with respect to improvement in facial function and hearing preservation. Method: Retrospective analysis conducted between 2002 and 2005 of 15 cases of posttraumatic facial nerve paralysis. A modified posterior tympanotomy approach was used in these patients. There were 13 males and 2 females aged between 12 and 43 years (mean age, 23.6 years). All the cases were operated by the senior author. Only patients with immediate onset facial paralysis were included in the analysis. These patients had received a full course of corticosteroids as conservative treatment before the surgical exploration. Intervention: Transmastoid facial nerve decompression using the modified technique. Outcome measurement: The clinical, audiometric, and radiologic evaluation was done for all patients. Analysis: Recovery of facial function and hearing status. Results: Eleven out of 15 patients had recovery of facial function to House Brackmann I-II. Two cases had HB III function. Two patients with bilateral paralysis had HB IV function. Only 1 case reported hearing deterioration. The rest of the patients maintained their preoperative hearing status. Conclusion: This technique provides insight into a favorable way of doing facial nerve decompression with an aim to considerably preserve the hearing.

Transmastoid Facial Nerve Decompression: Preliminary Results

Aim: To present our series of the first 5 patients who benefited from transmastoid facial nerve decompression with a brief description of the technique and midterm results.

Unilateral Congenital Facial Nerve Paralysis Secondary to a Benign Epithelioid Peripheral Nerve Sheath Tumor

A benign epithelioid peripheral nerve sheath tumor is described in the setting of congenital facial nerve (FN) paralysis. This is the first reported case in the English literature. A 10-month-old girl with unilateral congenital FN paralysis. Auditory brainstem evoked potential study, gadolinium-enhanced magnetic resonance imaging, temporal bone computed tomography, and transmastoid FN decompression with tumor resection. Follow-up for tumor recurrence and postoperative FN function. The child underwent a transmastoid FN exploration with resection of a 0.6-cm spherical tumor analyzed to be a benign epithelioid peripheral nerve sheath tumor. There is no evidence of recurrence, and FN function was unchanged at 1 year postoperatively. Benign epithelioid peripheral nerve sheath tumor can cause congenital facial nerve palsy.

Bell's palsy: Surgery based upon prognostic indicators and results

We studied 164 patients with Bell's palsy prospectively over the six-year period between August 1974 and June 1980. We found that the results of measuring tear production, submandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis--either unfavorable or favorable--for spontaneous return of facial function. When the test results were 26% or more of normal, 90% of the patients had complete recovery of function; these patients were given a favorable prognosis on the basis of the results of tests described above. The natural history of Bell's palsy in patients with an unfavorable prognosis could be improved if a transmastoid facial nerve decompression to the labyrinthine segment were performed. The results were better with this approach than with supportive or steroid therapy or transmastoid vertical-horizontal surgical decompression of the facial nerve.