1

Introduction

The incidence of recurrent facial palsy (RFP) is estimated to be 4% to 7% among acute facial palsy, and it may be unilateral or bilateral . The cause and mechanism of RFP are still unknown, but it is reported to be associated with Melkersson–Rosenthal syndrome, facial nerve tumors, otitis media, and family history in some study .

Similar to the dispute on Bell’s palsy, there is no consensus about the management of RFP. Conservative treatment is usually taken by physicians, but recurrence often affects the patients years later. Moreover, it is revealed that facial nerve function gradually worsens with every attack of facial palsy , thus it is plausible to prevent further episodes of facial palsy. There have been a few studies demonstrating efficacy of surgical decompression in preventing further episodes of facial palsy in RFP, but the extent of decompression is controversial .

In the past years, we performed facial nerve decompression on 12 cases of idiopathic RFP via middle cranial fossa approach, and the purpose of this article is to introduce our experience of preventing further episodes of idiopathic RFP by middle cranial fossa approach.

2

Materials and methods

A retrospective chart review of 18 cases with idiopathic RFP (at least 2 episodes of facial palsy on the same side), which were excluded from Melkersson–Rosenthal syndrome, facial nerve tumors and otitis media by physical examination and imaging techniques (including CT of temporal bone and MRI), was carried out. There were 14 females and 4 males. They were aged 16 to 46 years, with a mean of 27 years. The age at the first onset of facial palsy varied from 4 to 35 years. Electroneurography was performed on the patients with complete paralysis within 2 weeks after the last onset.

Internal auditory canal segment, meatal foramen, labyrinthine segment and geniculate ganglion were decompressed in 12 cases within 3 weeks after the last episode via middle cranial fossa approach, and conservative treatment (oral prednisolone, 1 mg/kg/d for 10 days) was provided to the 6 cases rejecting surgery. The patients were thereby divided into surgery group and control group accordingly.

The patients in the surgery group and the control group were followed up for 5.8 ± 1.3 years and 5.5 ± 1.0 years, respectively. Facial nerve function was assessed by House–Brackmann facial nerve grading system .

SPSS 18.0 software was used for data analysis. t-test was employed to compare the initial facial nerve function, and Fisher’s exact test was used to compare recurrence rate between the surgery group and the control group. P < 0.05 was deemed as significant difference.

2

Materials and methods

A retrospective chart review of 18 cases with idiopathic RFP (at least 2 episodes of facial palsy on the same side), which were excluded from Melkersson–Rosenthal syndrome, facial nerve tumors and otitis media by physical examination and imaging techniques (including CT of temporal bone and MRI), was carried out. There were 14 females and 4 males. They were aged 16 to 46 years, with a mean of 27 years. The age at the first onset of facial palsy varied from 4 to 35 years. Electroneurography was performed on the patients with complete paralysis within 2 weeks after the last onset.

Internal auditory canal segment, meatal foramen, labyrinthine segment and geniculate ganglion were decompressed in 12 cases within 3 weeks after the last episode via middle cranial fossa approach, and conservative treatment (oral prednisolone, 1 mg/kg/d for 10 days) was provided to the 6 cases rejecting surgery. The patients were thereby divided into surgery group and control group accordingly.

The patients in the surgery group and the control group were followed up for 5.8 ± 1.3 years and 5.5 ± 1.0 years, respectively. Facial nerve function was assessed by House–Brackmann facial nerve grading system .

SPSS 18.0 software was used for data analysis. t-test was employed to compare the initial facial nerve function, and Fisher’s exact test was used to compare recurrence rate between the surgery group and the control group. P < 0.05 was deemed as significant difference.

3

Results

The cases of the study are listed in Table 1 . Further episodes of facial palsy on the surgical side occurred in only one patient (8.3%) in the surgery group, while 4 of 6 cases (64.7%) in the control group had further episodes on the ipsilateral side (the side at which there were at least two episodes of facial palsy) (p < 0.05).

Table 1

Summary of 18 cases with idiopathic recurrent facial palsy.

Patient No.	FPE before treatment	FPE after treatment	Side	Initial FNF	Final FNF	Age at the first onset	Age	Follow-up (yr)
1	2	0	L	II	I	20	29	5
2	3	0	R	V	I	35	46	5
3	3	0	L	III	II	10	17	6
4	4	0	R	IV	II	16	29	6
5	2	0	L	III	I	4	27	7
6	6	1	L	VI	III	4	27	4
7	2	0	R	II	I	30	33	7
8	2	0	L	III	I	34	46	5
9	3	0	R	IV	II	11	16	4
10	4	0	L	IV	II	12	24	8
11	2	0	L	II	I	12	28	7
12	5	0	L	IV	II	13	22	5
13	3	2	R	IV	III	13	27	7
14	2	0	R	III	I	16	26	5
15	3	0	L	III	II	12	25	4
16	2	1	L	II	I	15	22	6
17	3	3	L	IV	IV	13	25	6
18	4	3	R	VI	V	18	32	5

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