Effectiveness of Surgical Treatment in Traumatic Facial Paralysis

Abstract

Introduction: In the etiology of facial nerve palsy, trauma is the most important. Our aim was to present our experience gained by evaluating the surgical approaches we have used in extratemporal and intratemporal facial nerve injuries and their long-term results, also to contribute to the consensus that will be formed on this subject. Materials and Methods: Thirteen patients among 24 patients who underwent surgery with a diagnosis of traumatic facial paralysis were evaluated in this study. The clinical response of these patients to treatment was examined by classifying them according to the House-Brackmann classification in the preoperative and postoperative periods. Results: Of the 13 patients, 9 had fractures due to temporal bone trauma, and 4 had nerve damage in the extratemporal part of the facial nerve. in the treatment, facial nerve decompression was performed using the middle fossa approach in 9 patients with temporal bone fractures. in the 4 patients with extratemporal facial nerve injury, graft repair or primary suturing was performed. in the postoperative period, the stages of the patients were III or below in 12 patients (92%), and only 1 (8%) patient remained in stage IV. Discussion: When the postop conditions of the patients were examined according to House-Brackmann staging, it was observed that surgical treatment caused a significant improvement in the functions of the facial nerve. Conclusions: Our results showed that surgery was an effective treatment method in patients with indications for traumatic facial paralysis.

Management of Non-Surgical Traumatic Facial Nerve Injuries

“…Physical rehabilitation aids in preventing muscle atrophy, promoting nerve regeneration, and retraining the facial muscles. 12 The role of physiotherapy has become even more crucial in cases involving muscle transfers or nerve grafts, where neural-muscular dynamics are significantly altered. 12 The emphasis on early and structured physiotherapy may partly explain the notable improvements observed in our patient cohort.…”

“…12 The role of physiotherapy has become even more crucial in cases involving muscle transfers or nerve grafts, where neural-muscular dynamics are significantly altered. 12 The emphasis on early and structured physiotherapy may partly explain the notable improvements observed in our patient cohort. Although we did not evaluate the effect of post-surgical physiotherapy in our study, this is an important part of the treatment, regardless of whether primary repair or muscle transfer is performed.…”

“…As elucidated by Erkan and Carre, the surgical decision between muscle and nerve transfers depends on the time elapsed since injury. 5,12 Our algorithm provides a structured approach to these decisions, ensu-…”

Comparing the Use of High-Dose to Standard-Dose Corticosteroids for the Treatment of Bell’s Palsy in Adults—A Systematic Review and Meta-analysis

“…In addition, included patients had a wide spectrum of disease (Bell’s palsy, Ramsay–Hunt syndrome, and traumatic facial palsy). The benefit of isolated corticosteroid therapy in patients with Ramsay–Hunt syndrome and traumatic palsy is limited, where patients often require antiviral (25) and surgical decompression, respectively (26). This therefore likely influenced the nonsignificant difference observed between groups.…”

Management of facial nerve trauma

“…Tension free end-to-end coaptation should be performed whenever possible. If necessary, a cable graft can be used from a donor such as the sural nerve, great auricular nerve, or nerve allograft [32][33][34]. Rarely, nerve transfer at the time of injury may be considered if no proximal facial nerve is available for anastomosis and the hypoglossal and masseteric nerve being the most common donor sources [35].…”