Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis.

Autor: Orhan KS; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey. Electronic address: ksorhan@istanbul.edu.tr., Sönmez S; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey. Electronic address: dr.saidsonmez@gmail.com., Kara H; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey., Avcı K; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey. Electronic address: kaganavci@istanbu.edu.tr., Polat B; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey., Çelik M; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey. Electronic address: mehmetcelik@istanbul.edu.tr., Orhan EK; University of Istanbul, Istanbul Faculty of Medicine, Department of Neurology, Division of Electro-neurophysiology, Istanbul, Turkey. Electronic address: ekorhan@istanbul.edu.tr., Güldiken Y; University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2023 Nov-Dec; Vol. 44 (6), pp. 103983. Date of Electronic Publication: 2023 Jul 10.
DOI: 10.1016/j.amjoto.2023.103983
Abstrakt: Objectives: To evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis.
Materials and Methods: This is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared.
Results: Eleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4-47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5-4 khZ and BC 0,5-3 kHz thresholds was observed between both techniques.
Conclusion: Even middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.
Competing Interests: Declaration of competing interest There is no conflict of interest among the author. There is no financial supporter of this study.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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