Therapy of immediate facial paresis in temporal bone fractures

Introduction 

A possible complication of the temporal bone fracture is facial nerve paresis. The facial nerve runs through a narrow bony canal in the petrous bone, making it particularly vulnerable to swelling-induced pressure. Most paresis result from nerve contusion, nerve stretching, or intraneural hematoma. Whether surgical decompression should be performed and the timing of surgery are controversial in the literature.

Methods 

Between 2017 and 2021, we operated on 7 patients with immediate facial paresis after petrous bone fracture aged between 5 and 67 years. The time interval between trauma and surgical intervention ranged from 2 to 15 days (mean 7.4 days). Facial function was assessed preoperatively clinically according to House-Brackmann scale and was at least grade IV.

Results 

The aetiologies of temporal bone fractures were falls (5) and traffic accidents (2). Facial decompression was performed in the region of the mastoid and the tympanum via a transmastoidal-transtympanic approach with removal of the incus, exposure of the facial nerve up to the geniculate ganglion and subsequent reconstruction of the ossicular chain using an autograft incus interposition. There was a significant improvement in facial function already in the short-term course in 3 cases.

Conclusion 

The facial nerve can be decompressed in its tympanic and mastoid course via a transmastoid-transtympanic approach. Whether and at what time facial nerve decompression should be performed must be decided individually in each case. The location of the fracture, as determined by a temporal bone CT scan, and electrophysiological studies of facial nerve activity can help determine the indication.

Publication History

Article published online:
24 May 2022