2017-18 HSC Section 3 Green Book

Reprinted by permission of Acta Otolaryngol. 2016; 136(12):1197-1200.

ACTA OTO-LARYNGOLOGICA, 2016 VOL. 136, NO. 12, 1197–1200 http://dx.doi.org/10.1080/00016489.2016.1201862

REVIEW ARTICLE

The timing of surgical treatment of traumatic facial paralysis: a systematic review Shaobing Xie a , b * , Xuewen Wu a , b * , Yanni Zhang a , b , Zhenhang Xu a , b , Tao Yang a , b and Hong Sun a , b a Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, PR China; b Province Key Laboratory of Otolaryngology Critical Diseases, Changsha, Hunan, PR China

ABSTRACT Conclusions: Surgical decompression performed within 2 weeks yields the best clinical prognosis for patients with TFP. This study also demonstrated that surgical exploration performed within 2 months results in acceptable outcomes. Objectives: The ideal timing for surgical intervention of traumatic facial paralysis (TFP) is still controver- sial. A systematic review was performed to appropriately determine the timing of surgical decompression. Methods: Related studies were identified by searching Pubmed, EMBASE, and Cochrane and reviewing the relevant reference lists until 1 March 2016. Surgical timing was classified into four sub-groups: < 2 weeks, 2 weeks–1 month, 1–2 months, and > 2 months. Results: Six studies including 119 patients (119 cases) fulfilled the study requirements. The number of patients who achieved perfect recovery of House-Brackmanm (H-B) grade 1 was 40 of 119 patients (33.6%). Good results were demonstrated in 94.4% (17/18) of patients managed with surgical decom- pression within 2 weeks vs 63.4% (64/101) of patients undergoing surgical intervention at > 2 weeks ( p ¼ 0.009).

ARTICLE HISTORY Received 25 April 2016 Revised 24 May 2016 Accepted 29 May 2016 Published online 6 July 2016 KEYWORDS Facial function; surgical timing; surgical decompression; traumatic facial never paralysis

Introduction Facial nerve paralysis is most likely to occur during temporal bone fractures as a consequence of traffic accidents or pene- trating or blunt trauma. Presently, there is no high-level lit- erature guiding treatment, and the optimal surgical timing to best preserve facial function remains debated. Many studies advocated a surgical decompression performed within 2 weeks to achieve a good recovery [ 1–3 ], Aslan et al. [ 4 ] and Kim et al. [ 5 ] believed that better results can be achieved with facial nerve decompression performed at the first 1 month. However, according to Ulug and Arif Ulubil [ 6 ], recovery of satisfactory facial nerve function can be achieved, regardless of the surgical timing during the first 3 months. Some studies have reported that surgical exploration of the facial nerve may be beneficial, even in very old injuries [ 7–9 ]. In sum, surgeons still did not reach a consensus in terms of surgical timing. However, the timing of surgical treatment and the potential surgical risks must be conveyed to the patient before the operation. This article aims to investigate the relationship between the surgical timing and the rate of recovery in an attempt to determine the ideal timing of surgical decompression for TFP. Materials and methods Related studies were identified by searching Pubmed, EMBASE, and Cochrane, and reviewing the relevant

reference lists until 1 March 2016. Included criteria were as follows: (1) decompression surgery was performed, (2) severe or complete traumatic facial paralysis: House-Brackmanm (H-B) grade 4–6 [ 10 ], (3) degree of denervation > 90 % by ENoG, (4) follow-up time > 6 months, and (5) sufficient patient data. The patient data extracted from the included studies were as follows: time from injury to surgery, clinical out- comes, follow-up period, age, pre-operative and post-opera- tive H-B grade. Surgical timing was classified into four sub- groups: (1) < 2 weeks after injury, (2) 2 weeks to 1 month after injury, (3) 1–2 months after injury, and (4) > 2 months after injury. Clinical outcomes were graded as ‘perfect’ and ‘good’ (H-B grade 1 was defined as perfect recovery and grade 1 or 2 as good recovery). Fisher’s exact test or the Chi-squared test was used for the statistical analysis across sub-groups. p < 0.05 was considered to be statistically significant. Statistical analysis was performed with SPSS 17.0 (SPSS Inc., Chicago, IL) Results Six articles were eligible for this study ( Figure 1 ). Among the identified articles, 119 patients (119 cases) were included ( Table 1 ). Eighteen patients underwent surgery within 2 weeks, 39 patients between 2 weeks and 1 month,

CONTACT Hong Sun, MD, PhD shjhaj@vip.163.com Department of Otolaryngology, Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China *These authors contributed equally to this paper. 2016 Acta Oto-Laryngologica AB (Ltd)

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