Endoscopic transcanal facial nerve decompression helpful in Bell's palsy
Endoscopic transcanal facial nerve decompression provides a less traumatic and improved exposure of the geniculate ganglion, and may also help prevent permanent severe facial sequela, suggests a recent study conducted at the Department of Otolaryngology Head and Neck Surgery, Shanghai 9th People's Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
The research is published in the American Journal of Otolaryngology.
Zhili Wang and colleagues explored the surgical effects of endoscopic facial nerve decompression in Bell's palsy.
The authors carried out a retrospective study which included a total of 15 patients with Bell's palsy. All had grade VI (House-Brackmann grading system) complete unilateral facial paralysis before surgery and a >95% reduction in amplitude on electroneurography testing compared to the unaffected side.
Their MRI results indicated perineural edema in the geniculate ganglion area. Endoscopic decompression surgery was performed soon after they presented at our hospital.
The time between onset of facial paralysis and surgery ranged from 25 to 93 days. All patients had no relevant surgical history or ear diseases.
The study revealed that at 1-year follow-up, 13 of the 15 (87%) patients had recovered to normal or near-normal facial function (House-Brackmann grade I-II), and all patients had reached House-Brackmann grade III or lower facial function. No obvious air-bone gap or sensorineural hearing loss occurred after surgery, and there were no severe complications or synkinesis.
Hence, the authors concluded that endoscopic transcanal facial nerve decompression provides a less traumatic and improved exposure of the geniculate ganglion, and may also help prevent permanent severe facial sequela.
They further inferred that the results of intraoperative facial nerve stimulation may be related to the length of time required for recovery. The optimal time of surgery after onset of paralysis needs to be investigated further, to identify a post-drug surgical therapy which may be more acceptable for patients. Patients' response to conservative treatments should be assessed as soon as possible so as not to delay surgery.
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