Decompression for Bell’s palsy: why I don’t do it

Abstract

All decompression surgery is based on the lack of understanding that Bell's palsy is a viral demyelinating disease that is longitudinal--not perpendicular--to the facial canal and that surgery cannot possibly help a viral disease. These findings exclude the etiologic possibility of an "ischemic paralysis" and are in accord with our logically derived belief that treatment directed to relieve neural entrapment is a wasted effort.

Search for Herpesviruses in cerebrospinal fluid of facial palsy patients by PCR

“…Opinions on facial nerve decompression surgery have changed over time, and many authorities today oppose the treatment [6,19]. Thus, finding a similar study to confirm or dispute the results of the endoneurial fluid samples of the study by Murakami et al [2] is unlikely.…”

“…According to Adour [6], Bell's palsy and Ramsay Hunt syndrome can be described as mononeuritis multiplex because they may present in mononeuritic or polyneuritic form. Besides the facial nerve, they can affect cranial nerves V, VIII, IX, and X. Interneural connections may act as virus pathways.…”

“…Also a theory of antero-and retrograde transport of viruses along nerves extending to the brainstem has been proposed [7]. Hypoesthesia, not uncommonly found in the paretic area [6], and inflammatory CSF findings seen in some Bell's palsy patients [1,8 Á11] could be indicators of central nervous system (CNS) involvement.…”

Facial Nerve Innervation and Facial Palsies

“…The House-Brackmann system is probably the one most commonly used and provides a global de fi cit measure that includes contraction and synkinesis (House 1983 ) . Adour's elegant regionally based system provides a facial paralysis recovery pro fi le (FPRP) from which subtractions can be made for symptoms of contracture, synkinesis, ptosis, etc., to generate a facial paralysis recovery index (FPRI) (Adour 2002 ) . This gives a numeric score for each patient, but it is complicated and requires calculations that make it unwieldy as a general tool for the clinician.…”

Measurement of the Facial Nerve Caliber in Facial Palsy

“…On the other hand, disapproval for this surgery also has been reported (11,12). Patrick et al (12) reported that there was insufficient evidence to make recommendations regarding facial nerve decompression for Bell's palsy.…”