2017-18 HSC Section 3 Green Book

ACTA OTO-LARYNGOLOGICA

Table 2. Clinical outcomes of different groups. Authors Years

Cases

Level of evidence

Mean age in years

Mean follow-up in months

Quaranta and Campobasso [10] Ashram and Badr-El-Dine [11]

2001 2014 2014 2011 2005 2012

9

IV

24

64.8 24.4

10 13 66 11 10

II

26.7 32.5 34.6 23.6

Aslan et al. [ 4 ] Hato et al. [ 3 ]

IV IV

> 6

> 12

Ulug and Arif Ulubil [6]

II

12

Yetiser [12]

IV

NR

> 6

Total NR: not reported.

locations, operation time, mechanisms of injury, and the method of classifying. Finally, a lack of sufficient data on clinical results of individual patients leads to a conclusion with less reliability. 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. Disclosure statement The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. Funding information This study was supported by the National Key Basic Research Program of China (973 Program), Grant No. 2014CB943003 and National Natural Science Foundation of China (NSFC), Grant no. 81300819 and Grant No. 81170912. The funders had no role in study design, data col- lection and analysis, decision to publish, or preparation of the manuscript. References [1] Cannon RB, Thomson RS, Shelton C, Gurgel RK. Middle fossa repair outcomes of traumatic facial nerve paralysis. Otolaryngol Head Neck Surg 2015;153:103–4. [2] Chang CY, Cass SP. Management of facial nerve injury due to temporal bone trauma. Am J Otol 1999;20:96–114. [3] Hato N, Nota J, Hakuba N, Gyo K, Yanagihara N. Facial nerve decompression surgery in patients with temporal bone trauma: analysis of 66 Cases. J Trauma 2011;71:1789–92. [4] Aslan H, Songu M, Eren E, Basogu MS, Ozkul Y, Ates D, et al. Results of decompression with middle cranial fossa approach or traumatic intratemporal fascial nerve injury. J Craniofac Surg 2014;25:1305–8. [5] Kim J, Moon IS, Shim DB, Lee WS. The effect of surgical timing on functional outcomes of traumatic facial nerve paralysis. J Trauma 2010;68:924–9. [6] Ulug T, Arif Ulubil S. Management of facial paralysis in tem- poral bone fractures: a prospective study analyzing 11 operated fractures. Am J Otolaryngol 2005;26:230–8. [7] Sanus GZ, Tanrio ver N, Tanriverdi T, Uzan M, Akar Z. Late decompression in patients with acute facial nerve paralysis after temporal bone fracture. Turk Neurosurg 2007;17:7–12. [8] Sofferman RA. 2005 Facial nerve injury and decompression. In: Nadol JB, Mckenna MJ, eds. Surgery of the Ear and Temporal Bone. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins. pp. 435–50.

important finding was that best clinical outcomes were yielded by undergoing surgical decompression at the first 2 weeks. Perfect results were achieved in 72.2 % undergoing surgery within 2 weeks, and good results in 94.4 % . In 1999, Chang and Cass [ 2 ] reviewed basic research studies by using animal models of TFP and advocated early surgery within 2 weeks to avoid damage to the endoneurial tubes. Our study supported their hypothesis. Usually, the earlier the surgery, the better the results [ 1 , 3 , 14 ]. However, patients with TFP frequently have intracranial or other complications [ 11 ], which explains the delay for specialized assessment and treat- ment. Our study showed that these patients should undergo surgery within 2 months to achieve acceptable results. The percentage of perfect recovery was 16 % in patients who got a surgical treatment at > 2 months, showing a significantly poorer prognosis compared with patients who underwent surgery within 2 months (38.3 % ; p ¼ 0.036). Compared with Hato et al.’s [ 3 ] review, we performed a statistical compari- son between patients who underwent surgery at 2 weeks to 1 month and patients who underwent surgery at 1–2 months; no statistically significant difference was found in the rate of perfect or good recovery. In this literature, the level of evi- dence is slightly low, four included articles were retrospective studies (graded as level IV) [ 3 , 4 , 10 , 12 ], and two were a pro- spective study (graded as level II) [ 6 , 11 ]. However, it is diffi- cult to perform a randomized, prospective, blinded study to investigate the ideal surgical timing; a retrospective study is an available method [ 2 , 16 ]. In this systematic review, we did not correlate clinical out- comes with sites of facial nerve injury and surgical approaches. Usually, the choice of surgical approach, to a certain extent, depends on the location of the lesion and hearing [ 4 ]. In cases of preserved hearing, the transmastoid approach is indicated [ 17 , 18 ]. A middle cranial fossa approach is required if the geniculate ganglion region of the facial nerve requires exploration [ 17–19 ]. Some studies dem- onstrated that a transmastoid extralabyrinthine approach was required when the labyrinthine segment of the facial nerve required decompression [ 18 , 19 ]. According to Hato et al. [ 3 ], they found no substantial difference in the recovery percent- age among the sub-groups in which patients were classified by the sites of facial nerve injury in their study. It seems that injury locations and surgical approaches do not make much difference when we investigate the relationship between the surgical timing and the rate of recovery. Several limitations are presented in this article. First, most included studies (66.7 % ) are retrospective case series contain- ing inherent biases. Second, the heterogeneity exists in surgi- cal techniques, surgical approaches, facial nerve injury

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