FACIAL NERVE DECOMPRESSION AFTER TEMPORAL

BONE FRACTURE

By: Yunia Chairunnisa Abdullah

Mentor: dr. Sri Wartati, Sp.THT-KL

Background
• Out tertiary otology center treats facial weakness and paralysis
after motor vehicle weakness
• We evaluate the patients with physical exam, audiogram, schrimers
test, and CT scan

methods
• Out protocol begins with oral steroid, and serial evaluations. Indications for
decompression and our unique transcanal approach to identify the sites for
decompression are described
Results

one hundred and forty

one patients with grade 4
or weakness underwent
decompression
Fourteen of 104 patients
(13%) presenting with
HB5 and 6 still had HB5
or HB6 after
decompression. Eighty
three of the 104 patients
achieved HB1 and HB2
at 6 month
Conclusions

This bangalore protocol facilitates

advantageous improvement in facial
function and conductive hearing loss
after traumatic facial nerve crush
injuries

The surgical technique, albeit

challenging help identify the fracture
lines, facilitates reconstruction of
disrupted ossicles and avoid
craniotomy
Introduction

Facial nerve injury after temporal bone fracture usually involves

the perigeniculate ganglion area. Additional site may be involved,
leading some surgeons to suggest middle cranial fossa,
transmastoid, or combined approaches to address those lesions
Introduction
• In bangalore india, our center commonly treat injuries after traffic
collisions

• Transcanal approach to the facial nerve exposes the labyrinthine portion

of the nerve through the first genu and geniculate ganglion, tympanic
segment, second genu and mastoid segment

• This approach enables the surgeon to follow the fracture course directly
to the site lesion, enables addressing the ossicles which are often
disrupted in trauma and avoids craniotomy
Methods

IRB approval was obtained

Patient Selection

Patients undergo physical examination

House brackmann grading, audiometri

CT scan and schirmer’s testing.

 • Hematorrhea
• Tympanic membrane ruptures or
hemotympanum with conductive hearing
Longitudinal Fractures loss
• Schirmer’s test positive

• Severe giddiness
• Vomiting
• Sensorineural hearing loss
Tranverse fractures
 If the patients has less than grade 4 at the time of
presentation, a trial of oral steroids in tapering
dosage along with physiotherapy is given. Followed
for 3 weeks and then evaluated for improvement.
 Patients who achieve eye closure after 3 weeks will
achieve complete or near complete recovery of facial
nerve function within 3 months without surgical
intervention
• .transcanal approach.
Tympanomeatal flap elevation
and the bone remove from the
canal and attic

• Fracture involve perigeniculate

region. Ossicles are already
disrupted.The bone removal in
attic is further extended to
expose the supralabyrinthine
• Fragmen of the
supralabyrinthine
cells which
typically impinge
into perigeniculate
ganglion removed
with drill and
curettes.
Labyrinthine facial
canal exposed
• After the
nerve is
exposed
and fracture
fragments
are
removed.
Results

HB scores of 141 patients

with post traumatic
unilateral facial nerve grade
4 or worse who underwent
decompression. The
perigenikulata area was
involved in 118/141 (84%) of
fractures
 14 of the 141
patients showed
HB6 or HB 5 at 6
months.120 of 141
showed HB2 or
HB1 post operative
scores
 Pre and post operative air
and bone conduction by site
injury/decompression
Discussion

We do not use
electrophysiologic testing,
but we have found
schirmer’s test helps
identify injuries proximal to
the greater superficial
petrosal nerve
we have found Failure to
achieve eye closure at 3 We found that 120/141
weeks indicates that the (92%) had favorable post
patients will be better operative outcomes
surgical intervention

0-50% of observation only

Statistic analysis found post traumatic paralyzes,
that patieints presenting 44% of steroid treated
with HB6 had worse paralysis, and 21% of
outcomes than those decompressed paralysis
presenting with HB5 or had HB1, and 10% of
HB4 these three treatments
options had HB6 outcomes
 The perigeniculate
13% of these most area was involved in
80% of the HB6 dan
affected patients 84% of these 141
HB5 patients ended
ended with HB6 dan cases, this area can
with HB2 dan HB1
HB5 be reached via the
middle cranial fossa
The transcanal technique, though
technically challenging give
access to the geniculate ganglion
and the labyrinthine facial nerve
without craniotomy
THANK YOU