HSC Section 8_April 2017

MIDDLE FOSSA APPROACH FOR TRAUMATIC FACIAL PARALYSIS

prognosis, MF decompression offers good long-term facial nerve outcomes. In cases with irreversible facial nerve injury, nerve grafting offers beneficial results when performed with MF decompression. Surgery should ideally be performed within 14 days of the onset of traumatic facial nerve paralysis, however, patients who present after this time frame and meet surgical criteria, may still benefit from decompression. Decompression in patients over 60 years should be performed to identify those patients with irreversible injuries, but these patients may not improve as much as their younger counterparts. In summary, MF decompression and repair is safe, effective, and provides good long-term facial nerve out- comes in patients with traumatic facial nerve paralysis and poor prognosis on electrical testing. In this series, all patients with traumatic complete paralysis and poor facial prognosis on electrical testing achieved a long-term outcome of HB III or better after MF approach for decompression and repair of the facial nerve. Surgical criteria for decompression includes immediate- onset, complete paralysis (HBVI), > 90%degeneration on ENoG, and absent voluntary EMG potentials. When a patient is stable after trauma, surgery is ideally performed within 14 days of trauma, with earlier decompression showing the best results. The current study further supports the safety and efficacy of the MF approach, demonstrating long-term facial nerve outcomes of HB III or better and minimal morbidity in these high-risk trauma patients with facial paralysis. CONCLUSION 1. Blake DM, Tomovic S, Jyung RW. Temporal bone fracture. Ear Nose Throat J 2014;93:16–25. 2. Johnson F, Semaan MT, Megerian CA. Temporal bone fracture: evaluation and management in the modern era. Otolaryngol Clin North Am 2008;41:597–618. 3. Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. Am J Otol 1997;18:188–97. 4. Nash JJ, Friedland DR, Boorsma KJ, Rhee JS. Management and outcomes of facial paralysis from intratemporal blunt trauma: a systematic review. Laryngoscope 2010;120:1397–404. 5. Maiman DJ, Cusick JF, Anderson AJ, Larson SJ. Nonoperative man- agement of traumatic facial nerve palsy. J Trauma 1985;25:644–8. 6. Adour KK, Boyajian JA, Kahn ZM, Schneider GS. Surgical and nonsurgical management of facial paralysis following closed head injury. Laryngoscope 1977;87:380–90. 7. Ho AL, Scott AM, Klassen AF, Cano SJ, Pusic AL, Van Laeken N. Measuring quality of life and patient satisfaction in facial paralysis patients: a systematic review of patient-reported outcome measures. Plast Reconstr Surg 2012;130:91–9. 8. Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac Trauma Reconstr 2015;8:1–13. 9. Lambert PR, Brackmann DE. Facial paralysis in longitudinal temporal bone fractures: a review of 26 cases. Laryngoscope 1984;94:1022–6. 10. Fisch U. Facial paralysis in fractures of the petrous bone. Laryngo- scope 1974;84:2141–54. REFERENCES

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