Decompression of the Facial Nerve in Bell's Palsy: A Historical Review

Abstract

This year, 1981, is the 50th anniversary of facial nerve decompression for Bell's palsy. The procedure was first suggested in 1923 but not performed until 1931. From the start, facial nerve decompression has generated disagreement regarding the indication and timing for surgical treatment and the anatomic extent of decompression. In each decade as the postonset time within which to perform surgical intervention has decreased, the anatomic extent of decompression has increased. Otologists continue to disagree, and we need to reevaluate our past and analyze how the difference may be resolved in the future. This critical review, in chronologic order, of the history and present status of facial nerve decompression is the necessary first step in resolving some of the persistent problems in surgical management of patients with Bell's palsy.

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

“…The history of facial nerve decompression reflects the lack of uniform criteria for selecting patients for surgery, for optimal timing of surgery, and for selecting areas for decompression [6].…”

“…In the 1930s, surgeons performed decompression if adequate facial function did not return after 3 months [6]. In the 1940s and 1950s, the waiting period before operation was reduced to 2 months [6]. By the 1960s, this time was reduced to 2 weeks; and in the 1970s, to 10 days [6].…”

“…In the 1940s and 1950s, the waiting period before operation was reduced to 2 months [6]. By the 1960s, this time was reduced to 2 weeks; and in the 1970s, to 10 days [6]. Finally, in the 1980s, Pulec [29] suggested that decompression is appropriate 5 days after onset of symptoms.…”

“…In 1932, decompression was needed only for the distal 1 cm of the facial nerve at the stylomastoid foramen. In 1939, decompression for the entire vertical segment was suggested [6]. In the 1940s and l950s, the vertical and pyramidal segments were decompressed.…”

Antiphlogistisch-rheologische Infusionstherapie der akuten idiopathischen Fazialisparese

“…Die Konsequenz aus dieser Situation ist, dass Patienten mit einer Bell-Parese, die bei unterschiedlichen Stellen ärztlichen Rat suchen, zum Teil extrem widersprüchli-che Aussagen erhalten. Diese Debatte wird schon lange geführt [5,23,32] und kann hier nicht im Einzelnen nachgezeichnet werden.…”