Intraoperative electrical stimulation for persistent, post-traumatic facial paralysis

Abstract

Approximately 7–10% of temporal bone fractures result in facial nerve paralysis. Treatment is dependent upon the severity of the nerve trauma and can range from conservative medical management to surgical intervention. A study by Hato et al. detailed the relationship between surgical timing and recovery rate for patients with facial nerve palsy secondary to temporal bone trauma. The rates of complete recovery and good recovery decline that the longer surgical intervention is delayed. We present the case of a 14-year-old male with a temporal bone fracture and delayed onset right-sided facial paralysis. This patient was treated with a transmastoid middle cranial fossa (MCF) approach with intraoperative electrical stimulation of the perigeniculate portion of the facial nerve. Despite a 53-day delay between trauma and surgical intervention, the patient’s facial function improved from House Brackmann (HB) grade VI to grade II within 6 months. Intraoperative facial nerve stimulation, which we have previously used for unresolved Bell’s palsy, may be useful for patients with post-traumatic, persistent facial paralysis.

Current Treatments and Future Directions for Facial Paralysis

“…84 ES holds promise as an adjunctive therapy for facial and peripheral nerve repair, demonstrated by feasibility, safety, and efficacy in improving outcomes in patients undergoing nerve repair surgery. 85,86 Concerns and limitations associated with ES remain, including the lack of established guidelines for its use, optimal parameters, patient compliance, and variability in individual response. Cost-effectiveness and technical limitations also impede ES adaptation.…”