Facial nerve outcomes after middle fossa decompression for Bell's palsy.

Abstract

OBJECTIVE:

Evaluate the long-term outcomes of facial nerve decompression via the middle fossa approach for Bell's palsy patients with poor prognosis based on clinical and electrodiagnostic testing.

STUDY DESIGN:

Retrospective case series.

SETTING:

Tertiary-care, academic medical center.

PATIENTS:

Fourteen patients underwent surgical decompression for Bell's palsy within 14 days of symptom onset from 2000 to 2012. Surgical criteria included greater than 90% degeneration on ENoG testing and no voluntary EMG potentials.

INTERVENTION:

Middle cranial fossa (MCF) bony decompression of the facial nerve, including the meatal foramen, labyrinthine segment, and geniculate ganglion.

MAIN OUTCOME MEASURES:

Long-term facial function, hearing results, and surgical complications.

RESULTS:

After MCF decompression, 10 patients (71.4%) regained normal or near-normal facial function (House-Brackmann [HB] I or II) within 1 year after surgery, and 5 of those patients (35.7%) improved to HB I. The remaining 4 patients (28.6%) improved to HB III. Patients older than 60 years (n = 3) had an HB III outcome and did significantly worse than the younger-than-60-years group (p = 0.002). The difference in preoperative and postoperative pure tone average and word recognition score was 2.1 dB and 0.9%, respectively. There were no major complications. Minor, transient complications occurred in 22.2% of patients.

CONCLUSION:

In patients with severe Bell's palsy at risk for a poor facial nerve outcome, MCF decompression of the facial nerve within 14 days of symptom onset provides good facial nerve outcomes with minimal morbidity.

• Authors: Richard B Cannon, Richard K Gurgel, Frank M Warren, Clough Shelton
• Journal: Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Otol Neurotol) Vol. 36 Issue 3 Pg. 513-8 (Mar 2015) ISSN: 1537-4505 [Electronic] United States
• PMID: 25058839 (Publication Type: Journal Article)

Topics

• Bell Palsy (diagnosis, surgery)
• Cranial Fossa, Middle (surgery)
• Decompression, Surgical (adverse effects, methods)
• Ear, Inner (surgery)
• Facial Nerve (surgery)
• Geniculate Ganglion (surgery)
• Hearing Loss (diagnosis, etiology)
• Hearing Tests
• Humans
• Middle Aged
• Retrospective Studies
• Treatment Outcome