2017-18 HSC Section 3 Green Book

S. XIE ET AL.

AddiƟonal records through arƟcle's references(n=27)

Pubmed (n=411) Embase (n=507) Cochrane(n=4)

IdenƟficaƟon Screening Eligibility Included

Duplicated arƟcle (n=302)

Detailed evaluaƟon (n=647)

Case reports and Unrelated topics(n=549)

Full-text arƟcle assessed for eligibility (n=98)

92 arƟcle excluded aŌer reading full text

Included in the study (n=6)

Figure 1. Flow chart of identifying eligible studies.

Similarly, the rate of good recovery was higher in patients who underwent surgery within 2 weeks (94.4 % , 17/18 patients) than those who underwent surgery > 2 weeks later (63.4 % , 64/101 patients), which had statistically significant difference ( p ¼ 0.009); the rate of good recovery was also higher in patients who underwent surgery within 2 months (73.4 % , 69/94 patients) than those who underwent surgery > 2 months later (48.0 % , 12/25 patients), which had a statis- tically significant difference ( p ¼ 0.015). No significant differ- ence was found in the rate of perfect or good recovery between the sub-group in which surgery was performed at 2 weeks to 1 month and the sub-group in which surgery was performed at 1–2 months ( p 1 ¼ 0.92, p 2 ¼ 0.516). Discussion The surgical timing for TFP has been discussed by surgeons for many years, since the early surgical decompression was first advocated by Farrior and Caldwell [ 13 ] in 1947. Liu et al. [ 14 ] demonstrated that the ideal timing for surgical decompression was within 1 month. Lieberherr et al. [ 15 ] reported on 14 patients who underwent surgical decompres- sion at 1–3 months achieving a good recovery of facial nerve function at a rate of 53–100 % . The timing of surgery is still a matter of debate. To our knowledge, this article is the first systematic review to investigate the optimum surgical timing using indi- vidual data of patients with TFP. In this study, the most

Table 1. Eligible data of the different studies. Cases Perfect recovery (%)

Good recovery (%)

< 2W 18 2W–1M 39 1M–2M 37 > 2M 25

13 (72.2) 12 (30.8) 11 (29.7) 4 (16.0)

17 (94.4) 28 (71.8) 24 (64.9) 12 (48.0)

37 patients between 1–2 months, and 25 patients more than 2 months. Eighteen patients who underwent surgical decompression within 2 weeks after injury achieved a perfect clinical out- come, with a recovery of 72.2 % ( Table 2 ), and a rate of good recovery of 94.4 % . The rate of perfect recovery and good recovery were 30.8 % and 71.8 % at 2 weeks to 1 month, and 29.7 % and 64.9 % at 1–2 months, suggesting a tendency to poorer clinical prognosis with later surgery. More prominent tendency was shown in patients who underwent surgical treatment > 2 months, and the rates of perfect and good recovery were 16.0 % and 48.0 % . There was a statistically significant difference in the per- centage of perfect recovery between patients who underwent surgery within 2 weeks (72.2 % , 13/18 patients) and those who underwent surgery > 2 weeks later (26.7 % , 27/101 patients; p < 0.001). There was also a statistically significant difference in the percentage of perfect recovery between patients who underwent surgical treatment within 2 months (38.3 % , 36/94 patients) and those who underwent surgical treatment > 2 months later (16.0 % , 4/25 patients; p ¼ 0.036).

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