Mediterr. J. Otol 2006; 3:127-132
Facial nerve injuries revisited
O. Nuri Özgirgin, Levent Özlüoğlu
Başkent University Hospital, Otolaryngology Department, Bahçelievler, Ankara, Turkey
Objectives: We present data from a series of traumatic peripheral facial nerve paralysis cases and review treatment options.
Method: A retrospective study that focuses on facial nerve palsies occurred by either temporal bone trauma, direct or iatrogenic injuries.
Participants: A total of 28 patients with peripheral facial nerve paralysis due to trauma were studied. Cases with acute-onset paralysis were managed surgically. Patients with delayed onset of paralysis were followed by either the House and Brackman (HB) grading system or electroneuronography (ENoG). Decompression of the facial nerve was performed when electroneurography findings suggested excitability lower than 5% as compared with the contralateral side.
Results: Among the 28 patients 20 had cranial trauma, one patient had a gunshot injury, 2 had extratemporal traumatic injury, and 5 had iatrogenic injuries. Among the patients with temporal bone fractures, 9 underwent facial nerve decompression. Two patients with extratemporal injuries, as well as the patient with the gunshot trauma, and 4 patients with iatrogenic injuries with total nerve injury also were treated surgically. The best result that could be achieved in cases of total transection of the nerve was HB grade 3, except for the patient with gunshot trauma, who demonstrated HB grade-4 paralysis. Facial nerves that have been partially injured showed improvement to either HB grade 1 or 2.
Conclusions: The onset of the paralysis in regard to the timing of the trauma and the degree of the paralysis are the most two important prognostic criteria in cases with facial injuries.. In cases with total nerve transection, the most favorable outcome will be no better than HB grade 3.