Facial Nerve Decompression by Middle Fossa Craniotomy in Post-Traumatic Paralysis

Objective: To describe our experience with the middle fossa craniotomy approach for decompression (MFCD) of the labyrinthine and tympanic segments of the facial nerve in facial nerve paralysis as a complication of temporal bone fracture.

Methods: Retrospective review of 10 cases of acute and total facial nerve paralysis after temporal bone fracture. The MFCD was performed in eight cases (six patients), and two cases did not have surgery. Demographic, clinical, and facial nerve function outcomes were assessed using the House-Brackmann (HB) grading scale.

Results: Facial function at presentation was HB 6 for all cases. All of the MFCD cases achieved a facial function of at least HB 3. Facial functions in the two nonsurgical cases were HB 5 and HB 6. The median time for onset of recovery of function was 21 days postoperatively (range, 17-61 days). Onset of recovery within 30 days after surgery was associated with better outcome. There were no serious postoperative complications.

Conclusion: MFCD is a safe and effective option for patients with total and acute facial paralysis after temporal bone fracture. Prompt diagnosis and management appear to be favorable predictive factors.