Functional outcome of the facial nerve paralysis after late surgical decompression in otic capsule-sparing fracture

Abstract

AbstractTemporal bone fracture (TBF) following head trauma is a well-known cause of facial nerve paralysis (FNP) and almost 22% of all skull fractures are TBF. It has been estimated that 25–70% of TBF are associated with FNP and otic capsule-violating fracture of the petrous portion of the temporal bone is more commonly associated with FNP, although otic capsule-sparing fracture is more common. (a) The incidence of FNP is reported to be 10–25% of otic capsule-sparing fracture. (b) With otic capsule-sparing fractures, FNP is often delayed 2–3 days, and is incomplete and temporary, with good recovery during a period of 6–8 weeks. Most clinicians seldom consider a surgical intervention in delayed FNP; however, surgical exploration may be required for complete recovery. The optimal timing for surgical exploration of traumatic FNP to best preserve facial function is currently controversial. Decompression surgery still has a beneficial effect if performed within 14 days of injury. However, late exploratory surgery is recommended in patients who do not experience recovery of facial nerve function, patients who cannot be operated on early, and who present 1–3 months after TBF with more than 95% denervation on electroneurography. Here, we report a case of delayed-onset FNP of otic capsule-sparing fracture with an excellent outcome after late surgical decompression at 6 months after trauma.