Comparative Outcome Analysis of Surgical Procedures Performed in Acute and Intermediate Facial Paralysis

Objective: The purpose of this study was to analyze outcomes after different surgical procedures for facial nerve (FN) restoration and facial muscles reanimation. Reviewed procedures included: free nerve graft, FN decompression in temporal bone, and spinal accessory nerve–facial nerve anastomosis (AFA).

Methods: Thirty-nine patients with total FN loss were included in the study. They were divided in two groups. The first group contained 20 patients with an intermediate facial paralysis. The interval between FN loss and the operation was from 1 to 6 months (mean, 4.7 months). All patients in the series had total FN function loss after acoustic neuroma surgery. In 12 patients, FN was anatomically intact but showed no function recovery due to stretch injury. Patients in the first group underwent AFA. The second group consisted of 19 patients with acute facial paralysis due to FN intratemporal injury. The interval between FN injury and surgery ranged from 2 to 30 days (mean, 17.4 days). Seventeen patients underwent FN exploration in the labyrinthine segment of the facial canal through a middle cranial fossa approach. FN was decompressed in mastoid bone in 2 patients. Therefore, FN decompression was performed in 14 patients. Surgical exploration was combined with free nerve graft in 5 patients with total disruption of FN continuity. House-Brackmann (HB) grading scale was used to evaluate FN functions in both groups. Preoperative electrophysiological testing demonstrated total facial muscle degeneration. The mean duration of follow-up was 4.65 years (range, 1–10 yrs).

Results: Overall, in the group after AFA, 4 patients (20 %) recovered from facial palsy with final HB grade II; 11 (55 %) patients had HB III and 5 patients (25 %) had HB IV–V. There were following intraoperative findings in the second group: FN injury in labyrinthine segment was observed in 17 cases. Two patients had FN injury in the mastoid segment. FN transection was performed in 5 patients, and we used nerve graft for FN repair. We found bone impingement and hematoma in 11 cases, and FN edema was identified in 3 patients. Among patients with FN decompression and nerve graft according to HB scale, 2 patients (10.5%) achieved HB I, 5 (26%) had HB II, 10 (53%) had HB III, and 2 (10.5 %) had HB IV–V.

Conclusion: AFA is a good option for facial muscles reanimation in intermediate facial paralysis. In total loss of FN function, early decompression is indicated for the best functional result in acute facial paralysis. Early nerve graft for nerve repair gives good results.