Traumatic Facial Palsy

Facial nerve palsy may represent an important complication of head trauma; yet, an adequate surgical treatment can reduce negative effects of such injuries. The surgical treatment usually consists of nerve decompression, nerve anastomosis and graft technique with n. auricularis magnus. In this study a retrospective analysis of the patients treated from the traumatic facial palsy in a ten-year period was performed. The patients were divided into groups according to etiology and intensity of facial damage. Clinical examination, topodiagnostics, electrodiagnostics and radiography were applied as routine. The House Brackmann scale was used for evaluation of results of medicaments and surgical therapy. The traumatic facial palsy was mainly incomplete (62.9%) with other frequent otologic symptoms. The temporal bone fracture was verified in 88.6% of patients and an intraoperative lesion of the nerve was predominantly suprastapedial (69.2%). Edema of nerve and fracture line were usually found. Different surgical techniques were applied (decompression in 84%, termino-terminal anastomosis in 9% and nerve graft in 7% of cases). The recovery of the facial function was good and fast in idiopathic cases with a significant difference between complete and incomplete palsy. In surgical cases, the best recovery was achieved with decompression while nerve anastomosis and nerve graft had similar time course and outcome in the House grades. Conclusion: The surgical therapy in selected cases of peripheral facial palsy gives good results. The decompression of the nerve is significantly more effective than nerve anastomosis and nerve graft, concerning both time and outcome. The type of surgery and the results depend on etiology, intensity, location and time of treatment of the facial palsy.