HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Reprinted by permission of Otolaryngol Clin North Am. 2018; 51(6):1077-1092.

Surgi cal Management of Acute Fac ial Pal sy

Daniel Q. Sun, MD a , * , Nicholas S. Andresen, MD a , Bruce J. Gantz, MD b

KEYWORDS Bell palsy Temporal bone fracture Facial nerve Facial nerve paralysis Facial nerve decompression Neurotology

KEY POINTS

Bell palsy and traumatic temporal bone fracture are common causes of acute facial palsy. Patients with complete facial paralysis (House-Brackmann 6/6) should undergo electro- physiologic testing (electroneurography [ENoG], electromyography [EMG]). Patients with complete paralysis (House-Brackmann 6/6) within 14 days of symptom onset, greater than 90% degeneration on ENoG testing, and absent EMG activity may benefit from surgical decompression. The return of facial nerve should not be expected for weeks to months following decom- pression surgery, and may be delayed up to 12 months.

INTRODUCTION

Common causes of acute facial palsy include Bell palsy and traumatic facial nerve injury secondary to temporal bone fracture. Bell palsy accounts for 75% of acute facial palsy cases. 1 Most patients with Bell palsy regain facial nerve function with conserva- tive treatment. However, a select group of patients has a worse prognosis and may benefit from surgical decompression of the facial nerve. 2 The evidence for the use of steroids and, in some cases, antivirals for Bell palsy has been reviewed elsewhere and is beyond the scope of this article 3–6 (see Dr Teresa M. O’s article, “ Medical Management of Acute Facial Paralysis ,” in this issue). Acute facial palsy secondary to traumatic nerve injury may also require surgical decompression and possibly nerve repair or grafting depending on the nature and extent of nerve trauma. This article uses Bell palsy as a framework to consider the work-up, indications, and techniques for the surgical management of acute facial palsy.

Disclosure: The authors have no conflicts of interest to disclose. a Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St 6th Floor, Baltimore MD, 21287, USA; b University of Iowa Hospitals and Clinics, 375 Newton Road, Iowa City, IA 52242, USA * Corresponding author. E-mail address: daniel-sun@uiowa.edu

Otolaryngol Clin N Am 51 (2018) 1077–1092 https://doi.org/10.1016/j.otc.2018.07.005 0030-6665/18/ ª 2018 Elsevier Inc. All rights reserved.

oto.theclinics.com

67