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Post Temporal Bone Fracture Facial Paralysis: Strategies in Decision Making and Analysis of Efficacy of Surgical Treatment

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Management of traumatic facial nerve injuries after temporal bone fractures is both challenging and controversial. The dilemma is whether to operate or not and if operating, when to operate and how much of the nerve to decompress. The aim of this study is to review our criteria for decision making in management of patients with temporal bone fracture induced facial nerve palsy, and analyze outcome of patients selected for surgical management. Review of 28 cases of temporal bone fracture between 2012 and 2016 was carried out. Patient assessment included clinical, audiological, computer tomography scans and electromyography (EMG) examinations. All 28 cases were initially started on conservative medical treatment. Based on criteria of complete clinical paralysis at onset, no improvement with conservative treatment and fibrillation potential in EMG, 10 cases underwent surgical decompression through the transmastoid approach. Among the 10 surgically-treated patients, lesions were predominantly found in geniculate ganglion area. Analysis of results after 12 months revealed 70% of cases who underwent surgery had House Brackmann (HB) Grade I–II recovery. Good recovery was achieved in all 18 medically treated patients (HB Grade I–II). Candidate selection based on accurate clinical judgment and judicious use of electrodiagnostic tests plays a vital role in outcomes in the treatment of post traumatic facial injury. Early surgical intervention gave better results in our study.

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Authors and Affiliations

  1. Department of ENT, University College of Medical Sciences and Associated GTB Hospital, New Delhi, India

    Deepika Vajpayee

  2. Department of ENT, Base Hospital and Army College of Medical Sciences, Delhi Cantt, 110010, New Delhi, India

    Ajay Mallick & Awadhesh K. Mishra

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  1. Deepika Vajpayee
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  2. Ajay Mallick
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  3. Awadhesh K. Mishra
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Correspondence to Ajay Mallick.

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All authors declare that they have no conflict of interest.

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All procedures performed were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Vajpayee, D., Mallick, A. & Mishra, A.K. Post Temporal Bone Fracture Facial Paralysis: Strategies in Decision Making and Analysis of Efficacy of Surgical Treatment. Indian J Otolaryngol Head Neck Surg 70, 566–571 (2018). https://doi.org/10.1007/s12070-018-1371-y

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  • DOI: https://doi.org/10.1007/s12070-018-1371-y

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