Safety and Efficacy of Endoscopic and Microscopic Techniques for Facial Nerve Decompression After Trauma: A Systematic Review and Meta-Analysis

Luis F. F. Paleare; Marcio Y. Ferreira; Anthony Hong; Ana B. Santos; Jhon E. Bocanegra-Becerra; Filipe V. Ribeiro; Lucca B. Palavani; Anna Pereira; Christian K. Fukunaga; João P. L. Scarramal; João G. R. Tedrus; Christian Ferreira; Rafael Martinez-Perez

doi:10.1055/a-2697-4554

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base
DOI: 10.1055/a-2697-4554

Original Article

Safety and Efficacy of Endoscopic and Microscopic Techniques for Facial Nerve Decompression After Trauma: A Systematic Review and Meta-Analysis

Authors

Luis F. F. Paleare

¹School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
Marcio Y. Ferreira

²Northwell, New Hyde Park, New York, USA
Anthony Hong

³School of Medicine, University of Costa Rica, San Pedro, San José, Costa Rica
Ana B. Santos

³School of Medicine, University of Costa Rica, San Pedro, San José, Costa Rica
Jhon E. Bocanegra-Becerra

⁴Academic Department of Surgery, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
Filipe V. Ribeiro

⁵Barão de Mauá University Center, Faculty of Medicine, Ribeirão Preto, São Paulo, Brazil
Lucca B. Palavani

⁶School of Medicine, Max Planck University Center, Indaiatuba, São Paulo, Brazil
Anna Pereira

⁷Faculty of Medicine, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
Christian K. Fukunaga

⁸Department of Medicine, FMABC University Center, São Paulo, São Paulo, Brazil
João P. L. Scarramal

⁹School of Medicine, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
João G. R. Tedrus

¹School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
Christian Ferreira

²Northwell, New Hyde Park, New York, USA
Rafael Martinez-Perez

¹⁰Geisinger Health System, Wilkes-Barre, PA, USA

Abstract

Background

Facial nerve palsy (FNP) is a result of facial and temporal trauma, often requiring surgery. Endoscopic or microscopic nerve decompression is one of the main surgical treatments. However, robust evidence on the safety and efficacy of these techniques remains scarce in the literature. This systematic review and meta-analysis aimed to synthesize current data on the outcomes of these surgical techniques for traumatic FNP (tFNP).

Methods

Following PRISMA guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library. Studies included patients who underwent endoscopic or microscopic surgical treatment for tFNP. Outcomes were classified by the House–Brackmann (HB) score: complications after surgery, normal facial function to recovery from mild dysfunction, moderate to moderately severe dysfunction, and severe dysfunction to total paralysis after surgery. Analyses were conducted separately, with subanalyses for the transmastoid (TM), middle cranial fossa (MCF), and combined TM + MCF routes in studies reporting.

Results

A total of 26 studies with 597 patients were included. The overall complication rate was 2% for endoscopic and 3% for microscopic. Endoscopic outcomes showed HB I–II 88, HB III–IV 6, and HB V–VI 3%. Microscopy revealed HB I–II 66, HB III–IV 29, and HB V–VI 2%. The complication rates for the TM approach were 0, MCF, and TM + MCF combined were 3 and 2%. Furthermore, the HB I–II score rates were 66 (TM), 70 (MCF), and 58% (TM + MCF).

Conclusion

Both techniques are safe and effective; better efficacy was analyzed with the endoscopic. Further studies with standardized populations are needed.

Keywords

facial decompression - facial nerve palsy - facial trauma - endoscopy - microscopy

Full Text

References

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