The Role of the Middle Fossa approach in the Management of Traumatic Facial Paralysis

Abstract

There are several controversial aspects to the management oftraumatleJacial para lysis. One ofthese involves the precise nature ofsurgical intervention once the decision to operate has been made. Between Jun e 1, 1984, and June 30, 1993, we surgically treated 220 cases of traumatic facial paralysis with good cochlear reserve by decompressing the tympanic and mastoid segments via a transmastoid approach fo llowed by decompression ofthe geniculate ganglion and the distal halfofthe labyrin thine segment via a middlef ossa approach. We discuss the results of surgery via the middleJossa approach, and we review the literature.

Cochlear implantation through the middle fossa: an anatomic study for a novel technique

“…Numerous authors have described variations in the middle fossa anatomy, and these are probably due to differences in the aeration of the temporal bones [2][3][4]7,8,11,12]. A number of different methods of identifying the position of the facial and trigeminal nerves, the IAM, and vascular bundles have also been well detailed [1,9,11,[13][14][15].…”

“…A number of different methods of identifying the position of the facial and trigeminal nerves, the IAM, and vascular bundles have also been well detailed [1,9,11,[13][14][15]. The mainissue isthatneurotologists use their experience in MCFA for removal of petroclival tumors or schwannomas, facial nerve exploration, vestibular nerve section or correction of cerebrospinal fluid leaks to locate the cochlea for CI [2][3][4]6].…”

“…However, the lack of definite landmarks on the temporal bone for locating the cochlear basal turn and its axis, associated with the significant individual variation in anatomic features, make the insertion of the cochlear implant array through this approach one of the most difficult surgical exercises to be performed in skull base surgery, even for highly skilled surgeons [2][3][4]7,8]. Furthermore, this approach may be associated with major complications including injury to the facial nerve and to the brain or vascular bundles due to the proximity of these structures [1][2][3][4][5][6][7][8][9][10][11].…”

Surgical Anatomy of Facial Nerve for Revision Transmastoid Surgery

“…Surgical anatomy of the perigeniculate area of the facial nerve has been studied mostly from the middle cranial fossa approach. [6][7][8] The structures used to identify the first genu on the anterosuperior aspect of the temporal bone are the arcuate eminence and the greater superficial petrosal nerve. 8 By transmastoid approach, the most commonly used structure to identify the geniculate ganglion is the cochleariform process.…”

Surgical management of facial nerve paralysis in the pediatric population

“…For acute facial nerve injuries, surgical intervention remains controversial [3,102]. The American Academy of Neurology does not recommend surgical decompression in children and suggests that more research ought to be conducted before using surgical decompression of the facial nerve in any population [41].…”