Yonsei Med J.  2018 May;59(3):457-460. 10.3349/ymj.2018.59.3.457.

Total Transcanal Endoscopic Facial Nerve Decompression for Traumatic Facial Nerve Palsy

Affiliations
  • 1Department of Otorhinolaryngology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
  • 2Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea. ismoonmd@yuhs.ac

Abstract

A few approaches can be used to decompress traumatic facial nerve paralysis including the middle cranial fossa approach or transmastoid approach depending on the site of injury. In some specific situation of treating traumatic facial nerve palsy whose injured site was confined from the geniculate ganglion to the second genu, transcanal endoscopic approach for facial nerve decompression can be used. We performed two cases of total endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve palsy. After a six month follow-up, both patients showed improvement in facial function by 2 grades according to House-Brackmann grade system. In terms of treatment outcomes, total transcanal endoscopic facial nerve decompression for traumatic facial nerve palsy is an alternative for lesions limited to the tympanic segment I, and has an advantages of being minimally invasive and is cosmetically acceptable without an external scar or bony depression due to drilling.

Keyword

Facial paralysis; endoscopy; transcanal; surgical decompression; temporal bone; fracture

MeSH Terms

Cicatrix
Cranial Fossa, Middle
Decompression*
Decompression, Surgical
Depression
Endoscopy
Facial Nerve*
Facial Paralysis
Follow-Up Studies
Geniculate Ganglion
Humans
Paralysis*
Temporal Bone

Figure

  • Fig. 1 Schematic drawings of total transcanal endoscopic facial nerve decompression. (A) After tympanomeatal flap elevation, fracture line across the tympanic segment of facial nerve was noted. The disarticulated incudostapedial joint was also found. (B) After removal of malleus and incus, decompression of facial nerve was performed using microdrills. Using this approach, facial nerve can be exposed from geniculate ganglion to second genu.

  • Fig. 2 Otologic manifestations and facial expressions of case 1. (A and B) Traumatic tympanic membrane perforation and conductive hearing loss were noted in the left ear. (C) Pre-operative CT scan, axial view. Note the left temporal bone fracture as shown by the blue arrow. (D-F) Pre-operative and (G-I) six-month post-operative photos of the patient. There was a significant improvement in facial nerve function from House-Brackmann grade IV to II.

  • Fig. 3 Otologic manifestations and facial expressions of case 2. (A) Pure tone audiometry showed bilateral conductive hearing loss (average ABG=30 dB). (B) Pre-operative CT scan, axial view. Note the left temporal bone fracture as shown by the blue arrow. (C) Three-month post-operative pure tone audiometry showed improvement. (D-F) Pre-operative and (G-I) five-month post-operative photos of the patient. Patient showed improvement in facial function from House-Brackmann grade V to III.


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