Endoscopic facial nerve decompression in post-traumatic facial palsies: pilot clinical experience

Endoscopic Ear Surgery for the Management of Traumatic Ossicular Disruption with Intact Tympanic Membrane

“…According to previous reports, perilymphatic stula commonly occurred in the stapes and round window [21], though after carefully examination, no occurrence of perilymphatic stula was observed in our cases series, EES could provide a clear and magni ed view for checking these areas, and reconstruction if necessary [22], the characteristic of endoscopic view ensured the surgical procedures being minimally invasive. TBF was found in 13 ears in this research, 4 ears were accompanied with FN injury, the perigeniculate area and tympanic segment was most commonly involved in the injury, which was in according with previous researches [4,11]. Though the timing of treatment of traumatic FN paralysis was under controversy [23], the case of traumatic FN paralysis combined with TOD was a good indicator for timely surgery, especially for the cases with severe immediate-onset facial paralysis and lack of response to the corticosteroid therapy.…”

“…Though the timing of treatment of traumatic FN paralysis was under controversy [23], the case of traumatic FN paralysis combined with TOD was a good indicator for timely surgery, especially for the cases with severe immediate-onset facial paralysis and lack of response to the corticosteroid therapy. A few approaches can be used for FN decompression depending on the injury sites, including transmastoid approach and the middle cranial fossa approach, however, it is a challenging to control these areas through traditional surgical approaches [11]. In this research, it showed EES was effective in the management of some selected FN injury, transcanal approach could allow the surgeons to control the whole tympanic segment, geniculate ganglion and lateral aspect of the labyrinthine portion, obviating the need of excessive removal of tympanic scute, canaloplasty, or a post-auricle incision and mastoidectomy, the FN function recovered very well in 6 months after surgeries in all cases.…”

“…However, up to date, most TOD were treated by ossiculoplasty under microscope [1,2,9]. Moreover, TOD is usually accompanied with temporal bone fracture (TBF) and facial nerve (FN) injury in some patients [10,11], whether the exclusive ESS could be quali ed to manage these complex injuries is unknown. In order to explore the e cacy of EES for management of TOD and the accompanied injuries, we retrospectively collected and analyzed a series of TOD cases with intact TM which were performed EES for ossiculoplasty and FN decompression in a portion of cases accompanied with FN injury.…”

Traumatic facial nerve paralysis dilemma. Decision making and the novel role of endoscope

“…Careful selection of patients for initial surgical decompression and subsequent endoscopic approach is critical ( Alicandri-Ciufelli et al., 2020 ). It has been widely accepted now that cases with immediate complete FNP and those with ENOG showing more than 90% degeneration or with EMG showing fibrillation potentials are candidates for surgical decompression ( Guntinas-Lichius et al., 2020 ).…”

Endoscope-assisted facial nerve decompression for traumatic tympanic segment of facial nerve paresis

“…6 The improvement in facial nerve function following transcanal endoscopic facial nerve decompression was reported to be 83.2%, with significant improvement in the postoperative air bone gap. 7 Another study mentioned the role of endoscope-assisted transmastoid approach facial nerve decompression involving the second genu and the labyrinthine segment of the facial nerve. 8 With regard to our case, the conventional transmastoid approach was initially performed.…”