Management and outcomes of facial paralysis from intratemporal blunt trauma: A systematic review

Abstract

The role of surgery versus nonsurgical interventions for this clinical entity remains inconclusive. Level 4 evidence studies predominate and are further hindered by poor description of outcome measures and incomplete data reporting. Exploratory pooling of data without formal meta-analysis suggests the need to compare any intervention to the natural course of healing, which overall appears to be favorable.

Nonsurgical Treatment for Posttraumatic Complete Facial Nerve Paralysis

“…Early surgical exploration is the typically recommended treatment for patients with complete facial paralysis secondary to temporal bone fractures associated with unfavorable ENoG parameters. [1][2][3][4][5][6][7] The evidence in support of this surgical dictum has, however, been weak, 5,6,11 and to our knowledge, there are no available studies reporting on the natural history regarding recovery in such a scenario. 5 Although a study evaluating the natural history alone is currently unconceivable, this Grade 0 mo 1 mo 2 mo 3 mo 6 mo 9 mo VI 28 28 24 1 0 0 V 0 0 0 0 0 0 I V 0 0 3 7 1 0 III 0 0 1 16 0 1 I I 0 0 0 4 1 6 1 2 I 0 0 0 0 1 1 1 5 study examines the recovery rates with nonsurgical treatment with oral corticosteroids in a consecutive cohort of 28 patients, and notes that good-quality recovery-although delayed-is almost universal.…”

Temporal bone fractures: evaluation of 77 patients and a management algorithm

“…[13] There were 7 (8.5%) CSF otorrhea cases in our research, 1 of which was seen with non-petrous fracture, and 6 of which were seen with petrous fractures. All of them were healed with conservative treatment (bed rest, head elevation, stool softeners, and prophylactic antibiotics).…”

“…In cases in which there is evidence of neurocranial injury on CT, angiography should be obtained in order to detect vascular injuries. [13] In conclusion, temporal bone fractures generally occur as a component of a severe head trauma, and traffic accidents are the most common etiologic factor. An otolaryngologist is an important part of the team together with the neurosurgeon who cares for patients with temporal bone fracture.…”

Unusual Mechanism of Facial Nerve Palsy Caused by Penetrating Neck Trauma

“…e incomplete FN palsy was treated conservatively, and surgical management was limited to soft tissue approximation and skin closure, and no attempt of FN exploration or surgical management was performed. e recommendations for surgical management are available only for FN palsy after temporal bone fracture or intratemporal blunt trauma, and those are not completely straightforward [10,11]. ere are no recommendations for surgical management of incomplete, extratemporal, blunt FN injury.…”