Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

Abstract

Background: To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP). Material-Methods: A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House–Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression. Results: At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade. Conclusion: Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.

Delayed repair of the facial nerve and its negative impacts on nerve and muscle regeneration

“…Peripheral nerve injuries are common and despite advances in treatments, they still have limitations in the complete restoration of motor and sensory functions [1][2][3][4][5][6][7][8][9][10][11]. Among the cranial nerves, the seventh nerve pair (facial-intermediate), when it is injured, loss of facial expression occurs, leading to functional and aesthetic loss of the face, affecting the ability of individuals to socialize [12][13][14][15].…”

Morphofunctional Improvement of the Facial Nerve and Muscles with Repair Using Heterologous Fibrin Biopolymer and Photobiomodulation

“…The seventh pair of cranial nerves, the facial nerve, is responsible for the maintenance and dynamics of the muscles of facial expression [ 1 , 2 ], their injury can be caused by several factors such as facial trauma [ 3 , 4 , 5 ], tumors [ 6 , 7 , 8 ], iatrogenesis [ 2 , 9 , 10 ], viral infections [ 11 , 12 ] and metabolic diseases [ 13 ]. The impact of damage to this nerve includes facial aesthetic imbalance and loss of ophthalmic, nasal, and oral functions.…”