Abstract
Objectives
To explore surgical timing of facial paralysis after temporal bone trauma.
Methods
The clinical data of the patients with facial paralysis after temporal bone trauma who underwent subtotal facial nerve decompression were retrospectively collected, and 80 cases followed-up for one year were enrolled in the study. They were divided into different subgroups according to the age, onset, and interval between facial paralysis and surgery, and the outcomes of facial nerve between different subgroups were compared.
Results
The number of patients who achieved good recovery of HB Grade I or II was 52 of 80 (65.0%). 43 of 66 cases (65.2%) in the younger group had good recovery of facial nerve in contrast to 9 of 14 cases (64.3%) in the elderly group, without significant difference ( p > 0.05). 9 of 13 cases (69.2%) in the delayed onset group had good recovery, while 43 of 67 cases (64.2%) in the immediate onset group had good recovery, without significant difference ( p > 0.05). The good recovery rate of the < 1 month group was statistically higher compared to the 3– 6 months group or the > 6 months group ( P < 0.05), while the good recovery rate of the < 1 month group was not statistically higher than that of the 1– 2 months group or the 2– 3 months group ( P > 0.05).
Conclusion
This study demonstrated that the good recovery rate of facial paralysis after temporal bone trauma was uncorrelated with age and onset. It was better to perform surgical decompression within 3 months after facial paralysis.
1
Introduction
Traumatic facial paralysis is not infrequent, and accounts for around 17% of peripheral facial paralysis . About 7%–10% temporal bone fractures lead to facial paralysis . When temporal bone trauma occurs, facial nerve may be pressed by hematoma or bony spicules, or may even be transected. Because those patients often have fatal head trauma, surgical management of facial paralysis is usually delayed. Currently, the surgical timing of traumatic facial paralysis is still controversial, although it has been discussed for many years. The most studies just involved < 30 cases of traumatic facial paralysis which were treated by surgical management . However, we analyzed outcomes of the largest series of patients with traumatic facial paralysis who underwent subtotal facial nerve decompression to our knowledge.
2
Materials and methods
2.1
Subjects
The clinical data of patients with unilateral traumatic facial paralysis after temporal bone trauma who underwent subtotal facial nerve decompression in our hospital from Feb., 1998 to Feb., 2013 were retrospectively collected, and only those who were followed up for one year were enrolled in the study.
2.2
Grouping
The patients were divided into different groups according to the age, onset, and interval between facial paralysis and surgery. They was divided into younger group (≤ 45 years) and elderly group (> 45 years), immediate onset group (facial paralysis onset within 48 h of trauma) and delayed onset group (facial paralysis onset after 48 h of trauma) according to the age and onset of facial paralysis, respectively. The cases were also divided into subgroups of < 1 month (surgery was performed within 1 month of facial paralysis onset), 1– 2 months (surgical time ranged from 1 to 2 months after paralysis onset), 2– 3 months (surgical time ranged from 2 to 3 months after paralysis onset), 3– 6 months (surgical time ranged from 3 to 6 months after paralysis onset), and > 6 months (surgery was performed 6 months later after paralysis onset). The outcomes of facial nerve between different groups were compared.
2.3
Surgery and preoperative findings
Electroneurography (ENoG) was performed within 2–3 weeks after facial paralysis, and electromusculography (EMG) was performed if patients were admitted after 3 weeks. > 90% neural degeneration on ENoG or absence of regeneration potentials on EMG was considered as indication of facial nerve exploration and decompression. The facial nerve was decompressed from stylomastoid foramen till labyrinthine segment of facial nerve through mastoid approach, including vertical segment, tympanic segment, geniculate ganglion and labyrinthine segment. The surgical details had been described sufficiently before, and this approach can avoid opening the skull and the subsequent possible complications . High-resolution CT of temporal bone was performed before surgery for each patient.
2.4
Facial nerve function evaluation
House-Brackmann (HB) grading system was introduced to evaluate facial nerve function. Facial nerve recovery to Grade I or II was deemed as good recovery.
2.5
Statistical analysis
SPSS 16.0 software was employed for data analysis. The good recovery rate between two groups was compared by the chi-square test, if normal distribution and homogeneity of variance as well as the sum of case number ≥ 40 were met. Or else, Fisher’s exact test was used for the comparison. P < 0.05 indicated significant difference.
2
Materials and methods
2.1
Subjects
The clinical data of patients with unilateral traumatic facial paralysis after temporal bone trauma who underwent subtotal facial nerve decompression in our hospital from Feb., 1998 to Feb., 2013 were retrospectively collected, and only those who were followed up for one year were enrolled in the study.
2.2
Grouping
The patients were divided into different groups according to the age, onset, and interval between facial paralysis and surgery. They was divided into younger group (≤ 45 years) and elderly group (> 45 years), immediate onset group (facial paralysis onset within 48 h of trauma) and delayed onset group (facial paralysis onset after 48 h of trauma) according to the age and onset of facial paralysis, respectively. The cases were also divided into subgroups of < 1 month (surgery was performed within 1 month of facial paralysis onset), 1– 2 months (surgical time ranged from 1 to 2 months after paralysis onset), 2– 3 months (surgical time ranged from 2 to 3 months after paralysis onset), 3– 6 months (surgical time ranged from 3 to 6 months after paralysis onset), and > 6 months (surgery was performed 6 months later after paralysis onset). The outcomes of facial nerve between different groups were compared.
2.3
Surgery and preoperative findings
Electroneurography (ENoG) was performed within 2–3 weeks after facial paralysis, and electromusculography (EMG) was performed if patients were admitted after 3 weeks. > 90% neural degeneration on ENoG or absence of regeneration potentials on EMG was considered as indication of facial nerve exploration and decompression. The facial nerve was decompressed from stylomastoid foramen till labyrinthine segment of facial nerve through mastoid approach, including vertical segment, tympanic segment, geniculate ganglion and labyrinthine segment. The surgical details had been described sufficiently before, and this approach can avoid opening the skull and the subsequent possible complications . High-resolution CT of temporal bone was performed before surgery for each patient.
2.4
Facial nerve function evaluation
House-Brackmann (HB) grading system was introduced to evaluate facial nerve function. Facial nerve recovery to Grade I or II was deemed as good recovery.
2.5
Statistical analysis
SPSS 16.0 software was employed for data analysis. The good recovery rate between two groups was compared by the chi-square test, if normal distribution and homogeneity of variance as well as the sum of case number ≥ 40 were met. Or else, Fisher’s exact test was used for the comparison. P < 0.05 indicated significant difference.
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