Long-term Outcomes After Middle Fossa Approach for Traumatic Facial Nerve Paralysis

Objectives: Controversy exists regarding the role of surgery for patients with skull base trauma and facial paralysis. Our goal is to report the long-term outcomes of early facial nerve decompression and repair via the middle fossa (MF) approach for patients with traumatic paralysis. Study Design: Retrospective case series. Setting: Academic medical center. Patients: There were 18 patients who met surgical criteria: immediate complete paralysis, greater than 90% degeneration on electroneurography (ENoG), and no voluntary electromyography (EMG) potentials within 14 days after trauma and 1 year minimum follow-up. Intervention: MF approach for traumatic facial paralysis and for irreversible injuries nerve grafting was performed. Main Outcome Measure: Long-term facial function, hearing results, and surgical complications. Results: At MF decompression, 11 patients had an anatomically intact facial nerve. Of these patients with intact nerves, 72.7% obtained normal to near normal facial function (HB I or II) at 1 year: 27.3% to HB I, 45.5% to HB II, and 27.3% to HB III. At surgery, seven patients were found to have injuries that required nerve grafting and 100% improved to HB III. For all patients, facial nerve function significantly improved after surgery (p < 0.01). The average difference in pure tone average and word recognition after surgery was +2.9 dB and +3.3%, respectively (p = 0.44; p = 0.74). Minor, transient complications occurred in three patients and an abscess required drainage in one patient, but no other major complications. Conclusion: In our series, all patients with traumatic complete paralysis and poor facial prognosis achieved a long-term outcome of HB III or better after MF approach for decompression and repair of the facial nerve.