Early Decompression of the Facial Nerve in Bell's Palsy

Abstract

Decompression of the facial nerve for 200 patients with Bell's palsy has been performed by the author during the past 17 years. These procedures were accomplished without injury to the facial nerve or inner ear. In no case was the incus removed nor the tympanic membrane or posterior bony canal wall disturbed with the exception of two translabyrinthine procedures in which the incus and inner ear were removed. Of 34 patients with normal nerve excitability preoperatively all had 100% recovery of facial motion. In 147 others followed for one year or more and whose nerve excitability was absent preoperatively, there was obtained an average of 80% recovery of motion and usually some degree of synkinesis. One patient who had a missing segment of nerve and a nerve graft performed failed to obtain any facial motion. Biopsy of facial nerve fibers during surgery has been found to be a feasible and useful technique. There is still no way to establish a prognosis when one still has a chance to avoid a bad result. The best one can do is to carefully follow serial electrical tests and perform surgery at the time when electrical studies begin to deteriorate. It is hoped that deterioration will develop slowly enough that a third degree injury will not have developed by the time that surgery is performed. Considering the results of this series of cases it would seem that the best results can be obtained by early surgical decompression for Bell's palsy. The patient must be informed of the possibility and the decision regarding the nature and timing of treatment should be a subjective one made after a careful analysis of the available facts and each patient's own circumstances. The availability of a promptly accomplished and precisely performed facial nerve decompression allows every patient to have a minimal risk of disabling permanent facial deformity.