Objective: We describe a rare case of a successful late surgical decompression of the facial nerve by the middle cranial fossa approach.
Design: Bell's palsy (idiopathic facial paralysis) is an acute, mostly unilateral, peripheral, facial-nerve paralysis that gradually resolves over time in 80–90% of cases. It is the most common cause of acute facial nerve paralysis (60–75%) and accounts for about 100 cases per million population per year. Controversy surrounds the etiology and treatment of Bell's palsy. Although treatment is mostly pharmacological, surgical treatment is a viable option in selected patients.
Patients and Results: We report a case of a 26-year-old woman who was diagnosed with Bell's palsy and submitted to standard medical treatment (antivirals and steroids). After 1 month, she remained with facial paralysis grade V House-Brackmann (H-B) and was submitted to a distal decompression of facial nerve trough with a left mastoidectomy due to indirect signals of distal facial neuritis on MRI (ENT Department).
The patient recovered to an H-B grade IV but with severe facial synkinesis. In a control CT, an asymmetry of the 1st portion of the facial canal was detected. A nerve decompression trough with a middle fossa approach was proposed. It was preformed about a year after initial symptoms with recovery to grade III H-B and less synkinesis.
Conclusion: Although controversial, surgical decompression of facial nerve with either trough mastoidectomy or a middle cranial fossa approach is a suitable option for selected patients.
