HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Surgical Management of Acute Facial Palsy

good recovery without surgical intervention. This management algorithm is shown in Fig. 2 . Candidates for surgical decompression are counseled in detail on the risks and ben- efits of the procedure. Iatrogenic facial nerve injury, hearing loss, and/or vestibular dysfunction are rare in experienced hands. Other risks associated with MCF surgery, including cerebrospinal fluid (CSF) leak, meningitis, and complications associated with temporal lobe retraction (eg, aphasia, seizure) are also extremely rare. It is impor- tant for patients to understand that surgical decompression does not guarantee but increases the likelihood for good recovery, and that recovery is likely not to occur until several weeks to months following surgery. Evidence supporting these surgical criteria comes from a prospective, multi- institutional, case-control study of 30 patients treated for Bell palsy during a 15-year period. 2 Criteria for inclusion were presentation within 14 days of symptom onset, complete paralysis (HB 6), greater than 90% degeneration on ENoG, and absent voluntary EMG activity. Patients meeting inclusion criteria were allowed to choose be- tween surgery (n 5 19) and oral steroid treatment (n 5 11). Patients electing for steroid treatment only were considered nonsurgical controls. A second group of patients (n 5 7) underwent surgical intervention 14 to 28 days after the onset of paralysis. Sur- gical intervention was facial nerve decompression through an MCF approach that included decompression of the distal IAC, meatal foramen, labyrinthine segment,

Fig. 2. Bell palsy management algorithm. qd, every day; tid, 3 times a day.

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