The outcome of facial nerve decompression via transmastoid approach in facial palsy secondary to the temporal bone fracture

OBJECTIVES: The aim of this study is to analyze the outcome of surgical management in traumatic facial paralysis secondary to temporal bone fracture. STUDY DESIGN AND METHODS: Prospective review was done in eleven patients with House-Brackmann’s grading more than IV. The facial nerves were decompressed via transmastoid approach. High-resolution computer tomography scan (HRCT), intra-operative findings and the functional recovery were analyzed. RESULTS: In all cases HRCT and intra-operative findings showed the fracture lines involved peri-geniculate area. In some cases, the fractures proceed antero-medially towards the facial hiatus and this can be approached via the supra-labyrinthine drilling with removal of the incus. Five patients experienced normal or near-normal recovery (HB grade I-II). Six patients recovered to HB grade III. CONCLUSION: The important deciding factors for facial nerve decompression are pre-operative HB grading more than IV, and HRCT revealed fracture line in the peri-geniculate area. Transmastoid facial nerve decompression is adequate to achieve favorable functional outcome